Lactate versus non-lactate metabolic acidosis: a retrospective outcome evaluation of critically ill patients.
Lactate versus non-lactate metabolic acidosis: a retrospective outcome evaluation of critically ill patients.
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DOI：
10.1186/cc3987
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发表时间：
2006-02
期刊：
影响因子：
--
通讯作者：
Kellum JA
中科院分区：
文献类型：
--
作者：
Gunnerson KJ;Saul M;He S;Kellum JA
酸碱异常在重症监护病房（ICU）很常见。在相似的pH范围内，呼吸性酸中毒和代谢性酸中毒的结果存在差异。某些形式的代谢性酸中毒（如乳酸中毒）似乎比其他形式（如氯化物中毒）的结果更糟。每种疾病的相对发病率尚不清楚。因此，我们设计了这项研究，以确定危重患者代谢性酸中毒的性质和临床意义。在一家三级医院对危重病人进行了一项观察性队列研究。对临床怀疑存在乳酸性酸中毒的危重患者进行筛选。全组住院死亡率为14%，住院时间12天，ICU住院时间5.8天。我们回顾了2001年1月1日至2002年6月30日期间在我院icu收治的9,799名患者的记录。我们选择了一个队列，其中治疗患者的临床医生要求测量动脉乳酸水平。我们排除了没有任何表征酸碱失调所需的必要变量的患者。共有851例患者（占ICU入院患者的9%）符合我们的标准。其中，548例患者（64%）患有代谢性酸中毒（标准碱过量< -2 mEq/l），这些患者的死亡率为45%，而无代谢性酸中毒的患者死亡率为25% （p < 0.001）。然后我们根据存在的主要阴离子（乳酸、氯离子或所有其他阴离子）对代谢性酸中毒病例进行亚分类。乳酸性酸中毒死亡率最高（56%）；强离子间隙（SIG）酸中毒为39%，高氯血症酸中毒为29% （p < 0.001）。逐步logistic回归模型确定血清乳酸、SIG、磷酸盐和年龄是死亡率的独立预测因子。在要求测量乳酸水平的危重患者中，乳酸和SIG是死亡率的强有力的独立预测因子，因为它们是代谢性酸中毒的主要来源。总的来说，代谢性酸中毒患者的死亡率几乎是非代谢性酸中毒患者的两倍。
Acid–base abnormalities are common in the intensive care unit (ICU). Differences in outcome exist between respiratory and metabolic acidosis in similar pH ranges. Some forms of metabolic acidosis (for example, lactate) seem to have worse outcomes than others (for example, chloride). The relative incidence of each type of disorder is unknown. We therefore designed this study to determine the nature and clinical significance of metabolic acidosis in critically ill patients. An observational, cohort study of critically ill patients was performed in a tertiary care hospital. Critically ill patients were selected on the clinical suspicion of the presence of lactic acidosis. The inpatient mortality of the entire group was 14%, with a length of stay in hospital of 12 days and a length of stay in the ICU of 5.8 days. We reviewed records of 9,799 patients admitted to the ICUs at our institution between 1 January 2001 and 30 June 2002. We selected a cohort in which clinicians caring for patients ordered a measurement of arterial lactate level. We excluded patients in which any necessary variable required to characterize an acid–base disorder was absent. A total of 851 patients (9% of ICU admissions) met our criteria. Of these, 548 patients (64%) had a metabolic acidosis (standard base excess < -2 mEq/l) and these patients had a 45% mortality, compared with 25% for those with no metabolic acidosis (p < 0.001). We then subclassified metabolic acidosis cases on the basis of the predominant anion present (lactate, chloride, or all other anions). The mortality rate was highest for lactic acidosis (56%); for strong ion gap (SIG) acidosis it was 39% and for hyperchloremic acidosis 29% (p < 0.001). A stepwise logistic regression model identified serum lactate, SIG, phosphate, and age as independent predictors of mortality. In critically ill patients in which a measurement of lactate level was ordered, lactate and SIG were strong independent predictors of mortality when they were the major source of metabolic acidosis. Overall, patients with metabolic acidosis were nearly twice as likely to die as patients without metabolic acidosis.
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