轻度高乳酸血症是急诊危重患者死亡的独立危险因素

Study of relative hyperlactatemia as an independent factor for increased mortality

目的分析轻度高乳酸血症的最佳阈值及其对急诊ICU危重症患者预后的评估作用。方法回顾性分析2013年3月～2015年3月所有入住急诊ICU的患者，采用约登指数筛选轻度高乳酸血症预测死亡率的最佳阈值，记录患者的一般资料、乳酸值、病情严重程度及既往病史，并用多元逻辑回归分析确定轻度高乳酸血症与死亡率的关系。结果在研究期间，共纳入2538名患者，乳酸平均值为（1．4±0．5）mmol／L，年龄55．2±20．1岁，APACHEII评分（21．8±7．9）分，应用血管活性药物比例为43％。1．35mmol／L为轻度高乳酸血症的最佳阈值，当高于此阈值时，住院患者死亡率（校正比值比为1．59，95％CI：1．28～1．99）和ICU患者死亡率（校正比值比为1．66，95％可信区间[CI]1．26～2．17）增加。结论入急诊ICU24h内乳酸高于1．35mmol／L（1．36～2．0mmol／L）为急诊危重症患者ICU死亡率和住院死亡率的独立危险因素。

Objective To determine the best cutoff threshold for serum lactate and to examine the corrahion between relative hyperlactatemia and mortality in emergency intensive care unit. Methods A retrospective review was conducted on all critically ill patients admitted from April 2013 to April 2015 in the emergency intensive care unit. Youden Index was employed to calculate to identify the best cutoff threshold that discriminated between survivors and nonsurvivors. Multivariate logistic regression was performed to determine the correlation between the relative hyperlactatemia and mortality. Results A total of 2,538 patients were included in the study with mean lactate of 1.4± 0.5 mmol/1, age of 55.2±20.1 years old, and chronic health evaluation （APACHE） II score of 21.8±7.9. Vasopressors were required in 43%. Lactate of 1.35mmol/1 was found to be the best cutoff threshold for the whole cohort. Relative hyperlactatemia was associated with increased hospital mortality （adjusted odds ratio （aorl.59, 95%CI1.28-1.99）, and ICU mortality （adjusted odds ratio （aorl.66, 95% CI1.26-2.17）. Conclusions Lactate of 1.36-2.0mmol/1 within the first 24 hours of emergency admission is an independent predictor of hospital and ICU mortality in critically ill patients.