Blood lactate concentration as prognostic marker in critically ill children
Blood lactate concentration as prognostic marker in critically ill children
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DOI：
10.2223/1364
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发表时间：
2005-08-01
影响因子：
3.3
通讯作者：
Cat, Mônica L.
中科院分区：
文献类型：
--
作者：
Koliski, Adriana;Cat, Izrail;Cat, Mônica L.
目的：为了评估使用乳酸作为组织灌注不足的标志物，并作为一个预后指标，在危重病patients.METHODS：前瞻性，纵向，观察性研究的75例入院的儿科ICU医院的联邦巴拉那大学，1998年11月至1999年5月。根据入院时乳酸水平分为A组（乳酸≥ 18 mg/dl）和B组（乳酸< 18 mg/dl）。根据结局，患者分为幸存者和非幸存者。A组于入院时、入院后6、12、24、48 h及入院后每24 h进行一次临床评估和动脉血标本采集。结果：A组50例，B组25例，均在入院后48 h内中断，两组均在入院后48 h内完成。A组表现出更多的低灌注临床体征（24/50）。入院后24小时内死亡的患者（95 mg/dl）和入院后24小时死亡的患者（28 mg/dl）入院时的平均乳酸水平存在统计学显著差异。入院24小时的乳酸水平显示出更好的敏感性（55.6%）和特异性（97.2%）作为death.CONCLUSIONS预测：大多数乳酸水平>或= 18 mg/dl的患者在入院时表现出低灌注的临床体征。入院时及入院后24小时乳酸水平的正常化或降低与更高的生存机会显著相关。
OBJECTIVE: To assess the use of lactate as a marker of tissue hypoperfusion and as a prognostic index in critically ill patients.METHODS: Prospective, longitudinal, observational study of 75 patients admitted to the pediatric ICU of Hospital de Clinicas of Universidade Federal do Parana, between November 1998 and May 1999. According to the lactate level on admission, patients were divided into group A (lactate > or = 18 mg/dl) and group B (lactate < 18 mg/dl). In terms of outcome, patients were classified into survivors and nonsurvivors. In group A, the clinical evaluation and the collection of arterial blood samples were performed on admission, at 6, 12, 24, 48 hours, and every 24 hours after that. In group B, they were carried out in the same way, but interrupted 48 hours after admission.RESULTS: Groups A and B consisted of 50 and 25 patients, respectively. Group A presented more clinical signs of hypoperfusion (24/50). There was a statistically significant difference regarding the mean lactate levels on admission between those patients who died within 24 hours of admission (95 mg/dl) and those who died 24 hours after admission (28 mg/dl). The lactate level at 24 hours of admission revealed better sensitivity (55.6%) and specificity (97.2%) as a predictor of death.CONCLUSIONS: Most patients with lactate levels > or = 18 mg/dl showed clinical signs of hypoperfusion on admission. The normalization or reduction of lactate levels at and after 24 hours of admission was significantly related with higher chances of survival.