Association between blood lactate levels, Sequential Organ Failure Assessment subscores, and 28-day mortality during early and late intensive care unit stay: A retrospective observational study
Association between blood lactate levels, Sequential Organ Failure Assessment subscores, and 28-day mortality during early and late intensive care unit stay: A retrospective observational study
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DOI：
10.1097/ccm.0b013e3181a0f919
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发表时间：
2009-08-01
影响因子：
8.8
通讯作者：
Bakker, Jan
中科院分区：
文献类型：
--
作者：
Jansen, Tim C.;van Bommel, Jasper;Bakker, Jan
目的：为了评估是否增加血乳酸水平的水平和持续时间与每日序贯器官衰竭评估（SOFA）评分和器官分项评分，并评估这些协会在早期和晚期阶段的重症监护病房stay.Design：回顾性观察研究。一所大学医院的混合重症监护病房。患者：134名异质重症监护病房患者。干预措施：无。测量和主要结果。我们计算了高于2.0 mmol/L的乳酸曲线下面积（乳酸（AUC>2））。在重症监护室住院的前28天内收集每日SOFA评分，以计算初始（第1天）、最大、总评分和平均评分。采用混合模型方差分析，每日乳酸盐（AUC>2）值与每日SOFA评分和器官分项评分相关。这也是在早期独立完成的。与正常乳酸血症患者（n = 78）相比，高乳酸血症患者（n = 56）的所有中位SOFA变量均较高（初始SOFA：9 [四分位距4-12] vs. 4 [2-7];最大SOFA：10 [5-13] vs. 5 [2-9];总SOFA：28 [10-70] vs. 9 [3-41];平均SOFA：7 [4-10]对比4 [2-6]，所有p <0.001）。每日乳酸盐（AUC>2）和每日SOFA之间的总体关系是每1天增加0.62 SOFA点。mmol/L乳酸盐（AUC>2）（95%置信区间，0.41-0.81，p < .00001）。在早期重症监护病房期间，乳酸盐（AUC>2）和SOFA之间的关系为1.01（95%置信区间，0.53-1.50，p < .0005），在晚期重症监护病房期间，这一关系降至0.50（95%置信区间，0.28-0.72，p < .0005）。呼吸（0.30，0.22-0.38，p <0.001）和凝血（0.13，0.090-0.18，p <0.001）子评分与乳酸盐最强相关（AUC>2）。血乳酸水平与SOFA评分密切相关。这种关系在重症监护室停留的早期阶段更强，这为早期复苏提供了额外的间接支持，以防止器官衰竭。结果证实，高乳酸血症可被视为器官衰竭的警告信号。(Crit Care Med 2009; 37：2369-2374）
Objectives: To evaluate whether the level and duration of increased blood lactate levels are associated with daily Sequential Organ Failure Assessment (SOFA) scores and organ subscores and to evaluate these associations during the early and late phases of the intensive care unit stay.Design: Retrospective observational study.Setting. Mixed intensive care unit of a university hospital.Patients: 134 heterogeneous intensive care unit patients.Interventions: None.Measurements and Main Results. We calculated the area under the lactate curve above 2.0 mmol/L (lactate(AUC>2)). Daily SOFA scores were collected during the first 28 days of intensive care unit stay to calculate initial (day 1), maximal, total and mean scores. Daily lactate(AUC>2) values were related to both daily SOFA scores and organ subscores using mixed-model analysis of variance. This was also done separately during the early (2.75 days) phase of the intensive care unit stay.Compared with normolactatemic patients (n = 78), all median SOFA variables were higher in patients with hyperlactatemia (n = 56) (initial SOFA: 9 [interquartile range 4-12] vs. 4 [2-7]; maximal SOFA: 10 [5-13] vs. 5 [2-9]; total SOFA: 28 [10-70] vs. 9 [3-41]; mean SOFA: 7 [4-10] vs. 4 [2-6], all p < .001). The overall relationship between daily lactate(AUC>2) and daily SOFA was an increase of 0.62 SOFA-points per 1 day.mmol/L of lactate(AUC>2) (95% confidence interval, 0.41-0.81, p < .00001). During early intensive care unit stay, the relationship between lactate(AUC>2) and SOFA was 1.01 (95% confidence interval, 0.53-1.50, p < .0005), and during late intensive care unit stay, this was reduced to 0.50 (95% confidence interval, 0.28-0.72, p < .0005). Respiratory (0.30, 0.22-0.38, p < .001) and coagulation (0.13, 0.090-0.18, p < .001) subscores were most strongly associated with lactate(AUC>2).Conclusions. Blood lactate levels were strongly related to SOFA scores. This relationship was stronger during the early phase of intensive care unit stay, which provides additional indirect support for early resuscitation to prevent organ failure. The results confirm that hyperlactatemia can be considered as a warning signal for organ failure. (Crit Care Med 2009; 37:2369-2374)