Early lactate measurement is associated with better outcomes in septic patients with an elevated serum lactate level
Early lactate measurement is associated with better outcomes in septic patients with an elevated serum lactate level
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早期乳酸测量与血清乳酸水平升高的脓毒症患者的更好结果相关
DOI：
10.1186/s13054-019-2625-0
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发表时间：
2019-11-11
期刊：
影响因子：
15.1
通讯作者：
Jin, Jun
中科院分区：
文献类型：
--
作者：
Chen, Hui;Zhao, Chenyan;Jin, Jun
背景重症监护病房（ICU）脓毒症患者乳酸测量的最佳时机仍存在争议，以及更早开始和重复乳酸测量是否会对乳酸水平升高的脓毒症患者产生影响仍有待探索。方法这是一项回顾性观察研究，包括入ICU后初始乳酸水平> 2.0 mmol/L的脓毒症患者，所有数据均来自重症监护III医疗信息集市(MIMIC-III) 数据库。感兴趣的主要暴露是早期乳酸测量，其定义为入住 ICU 后 1 小时内的初始乳酸水平测量。主要结局为28天死亡率。 结果共纳入2642名符合条件的受试者，其中738名在入院后1小时内完成初始乳酸测量的患者（EL组）和1904名在入住ICU后1小时以上完成初始乳酸测量的患者（LL组）。观察到早期乳酸测量对 28 天死亡率有显着的有益作用：调整后的比值比 (OR) 为 0.69 (95% CI 0.55–0.87；p= 0.001)，并且初始血管加压药给药时间的中介效应显着（平均因果中介效应 (ACME) - 0.018；95% CI − 0.005 大约至 − 0.036；p< 0.001)。延迟初始乳酸测量与风险调整后的 28 天死亡率之间存在密切关系（OR 1.04；95% CI 1.02–1.05；p< 0.001）。重新测量乳酸水平每延迟一小时，EL 组 28 天死亡率就会增加（OR 1.09；95% CI 1.04–1.15；p<0.001）。进一步分析表明，在初次乳酸测量后 3 小时重复测量会产生显着差异。结论 对于乳酸水平 > 2.0 mmol/L 的脓毒症患者，早期乳酸测量与较低的风险调整 28 天死亡率相关。初次使用升压药的时间较短可能有助于这种关系。对于入院 1 小时内测量乳酸水平的患者，在初次测量后 3 小时内重复测量乳酸水平是合适的。
BackgroundThe optimal timing of lactate measurement for septic patients in the intensive care unit (ICU) remains controversial, and whether initiating and repeating the lactate measurement earlier could make a difference for septic patients with an elevated lactate level remains unexplored.MethodsThis was a retrospective observational study that included septic patients with an initial lactate level > 2.0 mmol/L after ICU admission, and all data were extracted from the Medical Information Mart for Intensive Care III (MIMIC-III) database. The main exposure of interest was the early lactate measurement, which was defined as an initial lactate level measurement within 1 h after ICU admission. The primary outcome was 28-day mortality.ResultsA total of 2642 eligible subjects were enrolled, including 738 patients who had initial lactate measurements completed within 1 h (EL group) and 1904 patients who had initial lactate measurements completed more than 1 h after ICU admission (LL group). A significant beneficial effect of early lactate measurement in terms of 28-day mortality was observed: the adjusted odds ratio (OR) was 0.69 (95% CI 0.55–0.87;p= 0.001), and the mediation effect of the time to initial vasopressor administration was significant (average causal mediation effect (ACME) − 0.018; 95% CI − 0.005 approximately to − 0.036;p< 0.001). A strong relationship between delayed initial lactate measurement and risk-adjusted 28-day mortality was noted (OR 1.04; 95% CI 1.02–1.05;p< 0.001). Each hour of delay in remeasuring the lactate level was associated with an increase in 28-day mortality in the EL group (OR 1.09; 95% CI 1.04–1.15;p< 0.001). Further analysis demonstrated that repeating the measurement 3 h after the initial lactate measurement led to a significant difference.ConclusionsEarly lactate measurement is associated with a lower risk-adjusted 28-day mortality rate in septic patients with lactate levels > 2.0 mmol/L. A shorter time to the initial vasopressor administration may contribute to this relationship. Repeating the lactate measurement within 3 h after the initial measurement is appropriate for patients whose lactate levels were measured within 1 h of admission.