Lactate Level Versus Lactate Clearance for Predicting Mortality in Patients With Septic Shock Defined by Sepsis-3
Lactate Level Versus Lactate Clearance for Predicting Mortality in Patients With Septic Shock Defined by Sepsis-3
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DOI：
10.1097/ccm.0000000000003030
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发表时间：
2018-06-01
影响因子：
8.8
通讯作者：
Kim, Won Young
中科院分区：
文献类型：
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作者：
Ryoo, Seung Mok;Lee, JungBok;Kim, Won Young
目的：本研究旨在比较感染性休克后6小时乳酸水平和乳酸清除率的预后价值。并且，我们进行了它，以确定乳酸动力学败血症-3定义的脓毒性shock.Design：这项回顾性研究进行了前瞻性脓毒性休克registration.Settings：这项研究是在单一的城市三级中心。并且，所有患者在2010年至2016年期间接受了方案驱动的复苏捆绑治疗。患者：我们纳入了符合脓毒症-3定义的脓毒症休克患者，其中包括乳酸水平大于或等于2 mmol/L和血管加压剂的使用。干预措施：在脓毒症休克识别的初始和6小时内测量血清乳酸水平。测量和主要结果：乳酸盐清除率计算为（[初始乳酸盐- 6小时乳酸盐]/初始乳酸盐）x 100。分析测定的乳酸水平和乳酸清除率对28天死亡率的预后价值，并与随后的乳酸水平大于或等于2 mmol/L、大于或等于3 mmol/L、大于或等于4 mmol/L和小于10%、小于20%、小于30%的乳酸清除率进行比较。共有1，060例脓毒症休克患者，其中3，265例患者死亡（28天死亡率：25%）。在存活者中，两组的中位6小时乳酸水平低于非存活者，乳酸清除率高于非存活者（2.5 vs 4.6 mmol/L和35.4% vs 14.8%; p < 0.01）。校正混杂因素后，乳酸和乳酸清除率均与死亡率相关（比值比，1.27 [95%CI，1.21-1.34]和0.992 [95%CI，0.989-0.995]），但乳酸的预后价值显著高于乳酸清除率（曲线下面积，0.70 vs 0.65; p < 0.01）。随后的乳酸水平（2、3和4 mmol/L）和乳酸清除率（<10%、<20%和< 30%）的预后价值没有显著差异。然而，乳酸水平大于或等于2 mmol/L的敏感性最高（85.3%）。结论：我们的研究结果表明，乳酸和乳酸清除率都是有用的目标，脓毒症-3定义的感染性休克患者。6小时血清乳酸水平可以作为判断接受方案驱动复苏集束治疗的感染性休克患者预后的一个更简单、更有效的工具。
Objectives: This study aimed to compare the prognostic value of lactate level and lactate clearance at 6 hours after septic shock recognition. And, we performed it to determine lactate kinetics in the Sepsis-3 defined septic shock.Design: This retrospective study was performed from a prospective septic shock registry.Settings: This study was performed at single urban tertiary center. And, all patients were treated with protocol-driven resuscitation bundle therapy between 2010 and 2016.Patients: We included septic shock patients who met the Sepsis-3 definition, which involves lactate levels greater than or equal to 2 mmol/L and vasopressor use.Interventions: Serum lactate levels were measured at initial and 6 hours from septic shock recognition.Measurements and Main Results: Lactate clearance was calculated as ([initial lactate - 6-hr lactate]/initial lactate) x 100. The prognostic value of measured lactate levels and lactate clearance for 28-day mortality was analyzed and compared with that of subsequent lactate levels greater than or equal to 2 mmol/L, greater than or equal to 3 mmol/L, and greater than or equal to 4 mmol/L and less than 10%, less than 20%, and less than 30% lactate clearance. A total of 1,060 septic shock patients by Sepsis-3, 265 patients died (28-d mortality: 25%). In survivor, groups had lower median 6-hour lactate level and higher lactate clearance than nonsurvivors (2.5 vs 4.6 mmol/L and 35.4% vs 14.8%; p < 0.01). Both lactate and lactate clearance were associated with mortality after adjusting for confounders (odd ratio, 1.27 [95% CI, 1.21-1.34] and 0.992 [95% CI, 0.989-0.995]), but lactate had a significantly higher prognostic value than lactate clearance (area under the curve, 0.70 vs 0.65; p < 0.01). The prognostic value of subsequent lactate levels ( 2, 3, and 4 mmol/L) and lactate clearances (< 10%, < 20%, and < 30%) was not significantly differed. However, lactate levels of greater than or equal to 2 mmol/L had the greatest sensitivity (85.3%).Conclusions: Our findings indicate lactate and lactate clearance are both useful targets in patients with septic shock defined by Sepsis-3. Serum lactate level at 6-hour can be an easier and more effective tool for prognosis of septic shock patients who were treated with protocol-driven resuscitation bundle therapy.