Lactic acidosis not hyperlactatemia as a predictor of inhospital mortality in septic emergency patients
Lactic acidosis not hyperlactatemia as a predictor of inhospital mortality in septic emergency patients
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DOI：
10.1136/emj.2007.055558
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发表时间：
2008-10-01
影响因子：
3.1
通讯作者：
Baek, K-J
中科院分区：
文献类型：
--
作者：
Lee, S-W;Hong, Y-S;Baek, K-J
目的：比较乳酸酸中毒和高乳酸血症的预后能力，并确定代谢性酸中毒对败血症患者预后的影响。方法：126例严重败血症或感染性休克患者在急诊科接受前瞻性研究。分别于入院时(0h)和入院后4h记录血流动力学指标、简化急性生理学评分(SAPS)II、动脉血气分析和血乳酸水平。使用SAPS II评分计算死亡率，并与不同血乳酸水平和动脉pH值下的实际住院死亡率进行比较。用Kaplan-Meier法分析乳酸酸中毒和重度高乳酸血症患者的生存曲线。结果：计算的死亡概率从发病时的35.7%(95%可信区间30.2~41.2)下降到发病后4h的29.3%(95%可信区间24.2~34.4)。27.0%的患者(34例)在医院死亡。动脉血pH和SAPS II评分是脓毒症患者0h和4h死亡的独立预测因素，血清乳酸水平与病情严重程度和代谢性酸中毒密切相关。卡普兰-迈耶生存分析显示，乳酸中毒患者的住院病死率明显高于pH值正常和乳酸水平正常的患者(p<；0.001，p<；0.001经对数等级检验)。结论：严重败血症和感染性休克患者中，乳酸酸中毒较高乳酸血症更能准确预测住院病死率。当尝试使用血清乳酸水平预测败血症患者的预后时，应考虑酸碱状态。
Objective: To compare the prognostic abilities of lactic acidosis and hyperlactatemia and determine the influence of metabolic acidosis when attempting to predict the outcome of septic patients using serum lactate levels.Method: 126 patients with severe sepsis or septic shock were prospectively included in this study at an emergency department. Haemodynamic variables, simplified acute physiology score (SAPS) II, arterial blood gas studies and serum lactate levels were obtained at the time of presentation (0 h) and 4 h after presentation. The probability of mortality was calculated using SAPS II scores and compared with actual inhospital mortality at different serum lactate levels and arterial pH. Survival curves for lactic acidosis and severe hyperlactatemia were analysed using the Kaplan-Meier method.Results: The calculated probability of mortality decreased from 35.7% (95% CI 30.2 to 41.2) at presentation to 29.3% (95% CI 24.2 to 34.4) at 4 h post-presentation. 27.0% of patients (34) died in hospital. Arterial pH and SAPS II scores were independent factors for predicting mortality of septic patients, at 0 h and 4 h. Serum lactate levels were closely related to severity of illness and metabolic acidosis in septic patients. Patients with lactic acidosis had significantly higher inhospital mortality than patients with normal pH and normal lactate levels by Kaplan -Meier survival analysis as determined based on measurements made at 0 h and 4 h (p < 0.001, p < 0.001 by the log-rank test, respectively). No significant difference in survival was found between patients with hyperlactatemia and those with normal pH and serum lactate levels.Conclusion: Lactic acidosis not hyperlactatemia was found to predict inhospital mortality more exactly in severe sepsis and septic shock patients. The acid-base state should be considered when attempting to predict the outcome of septic patients using serum lactate levels.