Agreement between peripheral venous and arterial lactate levels
Agreement between peripheral venous and arterial lactate levels
复制标题
DOI：
10.1016/s0196-0644(97)70220-8
复制
发表时间：
1997-04-01
影响因子：
6.2
通讯作者：
Touger, M
中科院分区：
文献类型：
--
作者：
Gallagher, EJ;Rodriguez, K;Touger, M
研究目的：验证外周静脉血乳酸(V-LACT)可替代动脉血乳酸(A-LACT)预测动脉血乳酸的假设。方法：对74例在城市公立教学医院就诊的ED患者的配对A-LACT和V-LACT进行前瞻性比较，其中70%的患者A-LACT异常。A-Lact和V-Lact呈强相关(r(2)=0.89)。同时对止血带时间和拔除A-Lact和V-Lact之间的时间进行多变量调整对这种相关性没有影响。虽然V-Lact和A-Lact的平均差值仅为0.22 mm o l/L，但在单个患者的配对测量之间包含95%不一致的范围是-1.3 m o l/L~1.7 m o l/L。当A-Lact和V-Lact水平分别被分为正常组和异常(升高)组时，V-Lact显示出94%的敏感性(95%可信区间[CI]，83%~99%)，57%的特异性(95%可信区间，34%~78%)，阳性似然比为2.2，阴性似然比为1。A-Lact值被用作这些计算的标准。结论：在该队列患者中，A-Lact和V-Lact之间的相关性很高，但一致性并不完美。发现V-Lact正常可显著降低动脉高乳酸血症的几率，但如果V-Lact升高，则仅略有增加。在用V-Lact代替A-Lact的常规替代中应谨慎使用。
Study objective: To test the hypothesis that measurements of peripheral venous lactate (V-LACT) can be substituted for arterial lactate (A-LACT) in predicting arterial hyperlactacidemia.Methods: We conducted a prospective comparison of paired A-LACT and V-LACT measurements obtained from a convenience sample of 74 ED patients who presented to an urban, public teaching hospital, 70% of whom had abnormal A-LACT.Results: Mean A-LACT and V-LACT were 2.8 mmol/L and 3.0 mmol/L, respectively. A-LACT and V-LACT were strongly correlated (r(2)=.89). Simultaneous multivariate adjustment for tourniquet time and for time elapsed between drawing of A-LACT and V-LACT had no effect on this correlation. Although the mean difference between V-LACT and A-LACT was only .22 mmol/L, the range that included 95% of the disagreement between paired measurements in individual patients was -1.3 mmol/L to 1.7 mmol/L. When A-LACT and V-LACT levels were each divided into normal and abnormal (elevated) groups, V-LACT showed 94% sensitivity (95% confidence interval [CI], 83% to 99%), 57% specificity (95% CI, 34% to 78%), a positive likelihood ratio of 2.2, and a negative likelihood ratio of .1. A-LACT values were used as the criterion standard for these calculations.Conclusion: Correlation between A-LACT and V-LACT was high in this cohort of patients, but agreement is imperfect. The odds of arterial hyperlactacidemia appear to be reduced substantially by the finding of a normal V-LACT but are only marginally increased if the V-LACT is increased. Caution should be used in the routine substitution of V-LACT for A-LACT.