摘要
【摘要】目的明确不同降钙素原脓毒症患者早期乳酸与短期预后的关系。方法本研究为回顾性队列研究,收集2014年9月1日至2017年6月30日期间南华大学附属第一医院急诊重症监护室(EICU)收治的,且符合sepsis-3脓毒症标准的195例患者数据。采用二元logistic回归分析方法调整潜在混杂。按降钙素原分层,分析并比较各亚组间早期乳酸与脓毒症28天死亡的关系。结果研究共纳入脓毒症患者195例,其中死亡71例(36.41%)。调整潜在混杂因素后分析显示,早期乳酸是脓毒症28天死亡的独立危险因素(OR,1.29;95%CI,1.12—1.48)。进一步按降钙素原(Procalcitonin,PCT)分层,调整后显示,各亚组间早期高乳酸血症与脓毒症28天死亡的关系不同:当PCT〈10μg/L时,未证实早期乳酸与脓毒症28天死亡有关(OR,0.87;95%CI,0.54—1.40);当10μg/L≤PCT〈70μg/L,早期高乳酸血症是脓毒症28天死亡的独立危险因素(OR,1.59;95%CI,1.06~2.37);而当PCT〉70μg/L时,伴高乳酸血症的脓毒症患者28天死亡风险更高(OR,2.02;95%CI,1.25—3.28)。结论按降钙素原分层能提高早期乳酸对脓毒症短期预后评估的准确性。
Objective Clarify the relationship between early lactate and short-term prognosis of sepsis in different levels of procalcitonin. Methods In this retrospective cohort study , 195 patients who met the sepsis-3 criteria in the emergency intensive care unit (EICU) of The First Affiliated Hospital of Uni- versity of South China from September 1, 2014 to June 30, 2017 were collected. Multiple logistic regression analysis was used to adjust the potential confounding. After stratified by PCT, the relationship between early lactate and sepsis 28-day deaths was analyzed and compared between subgroups. Results 195 cases of sep- sis were included in the study, and the 28-day mortality was 36.41% (n =71 ). Early lactate is an independ- ent risk factor for the 28-day death of sepsis After adjusted for potential confounding factors ( OR, 1. 29 ; 95%CI, 1.12-1.48). Further stratification analysis was carried out according to the level of calcitonin ( PCT), results show in adjusted : the relationship between early hyperlaetacidemia and the 28-day death of sepsis was different among the subgroups. When the PCT level is less than 10 μg/L, It is not confirmed that early lactate is associated with the 28-day death of sepsis (OR, 0. 87; 95%CI, 0. 54-1. 40 ) . When the PCT level is less than 70 μg/L and is greater than 10 p.g/L, early hyperlactacidemia is the independent risk fac- tors for the 28-day death of sepsis ( OR, 1.59; 95%CI, 1.06-2.37), and when the PCT level is greater than 10 μg/L, Further increase in the risk of 28-day death for sepsis (OR, 2.02; 95%CI, 1.25-3.28). Condusions The accuracy of early lactate for risk stratification of sepsis was further improved by stratified according to procalcitonin.
作者
黄亮维
彭正良
卿国忠
张克娜
肖康
刘于秋荷
伍成霞
Huang Liangwei, Peng Zhengliang, Qing Guozhong, et al.(The First Affilia- ted Hospital of University of South China, Hengyang 421001, Hunan, Chin)