Emergency Department Lactate Is Associated with Mortality in Older Adults Admitted With and Without Infections
Emergency Department Lactate Is Associated with Mortality in Older Adults Admitted With and Without Infections
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DOI：
10.1111/j.1553-2712.2010.00681.x
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发表时间：
2010-03-01
影响因子：
4.4
通讯作者：
Pines, Jesse M.
中科院分区：
文献类型：
--
作者：
del Portal, Daniel A.;Shofer, Frances;Pines, Jesse M.
目的：急诊科（艾德）的血清乳酸值与不同人群危重患者的死亡率相关。本研究探讨血清乳酸值测量的艾德是否与死亡率在老年患者入院，无论有无infections.Methods：这是一个回顾性队列研究，在两个城市教学医院。研究人群包括1，655名年龄大于等于65岁的老年艾德患者（2004-2006年），他们在入院前测量了血清乳酸。通过审查国际疾病分类第九修订版（ICD-9）入院诊断代码确定是否存在感染。住院期间的死亡率通过回顾住院记录确定。结果：与血清乳酸水平< 2.0 mmol/L的患者相比，感染患者血清乳酸水平升高≥ 2.0 mmol/L与住院期间（RR = 1.9 ~ 3.6）、30 d（RR = 1.7 ~ 2.6）和60 d（RR = 1.4 ~ 2.3）死亡率的相对危险度（RR）呈线性相关。在无感染的患者中，观察到类似的相关性（住院期间RR = 1.1至3.9，30天时RR = 1.2至2.6，60天时RR = 1.1至2.4）。在这两组患者中，血清乳酸与死亡率的相关性比其他两项常用实验室检查（白细胞计数和血清肌酸酐）中的任何一项都更大。结论：在65岁以上的住院患者的广泛队列中，较高的艾德乳酸值与较高的死亡率相关，无论是否存在感染。学术急诊医学2010; 17：260-268（C）2010，学术急诊医学学会。
Objectives:Serum lactate values in the emergency department (ED) have been associated with mortality in diverse populations of critically ill patients. This study investigates whether serum lactate values measured in the ED are associated with mortality in older patients admitted to the hospital, both with and without infections.Methods:This is a retrospective cohort study performed at two urban teaching hospitals. The study population includes 1,655 older ED patients (age >= 65 years) over a 3-year period (2004-2006) who had serum lactate measured prior to admission. The presence or absence of infection was determined by review of International Classification of Diseases Ninth Revision (ICD-9) admission diagnosis codes. Mortality during hospitalization was determined by review of inpatient records. Mortality at 30 and at 60 days was determined using a state death registry.Results:In patients with infections, increasing serum lactate values of >= 2.0 mmol/L were linearly associated with relative risk (RR) of mortality during hospitalization (RR = 1.9 to 3.6 with increasing lactate), at 30 days (RR = 1.7 to 2.6), and at 60 days (RR = 1.4 to 2.3) when compared to patients with serum lactate levels of < 2.0 mmol/L. In patients without infections, a similar association was observed (RR = 1.1 to 3.9 during hospitalization, RR = 1.2 to 2.6 at 30 days, RR = 1.1 to 2.4 at 60 days). In both groups of patients, serum lactate had a greater magnitude of association with mortality than either of two other commonly ordered laboratory tests, leukocyte count and serum creatinine.Conclusions:Higher ED lactate values are associated with greater mortality in a broad cohort of admitted patients over age 65 years, regardless of the presence or absence of infection.ACADEMIC EMERGENCY MEDICINE 2010; 17:260-268 (C) 2010 by the Society for Academic Emergency Medicine.