年龄对乳酸清除率预测脓毒性休克患者预后价值的影响

Effects of age on the use of lactate clearance rate to predict prognosis in septic shock patients

目的:探讨年龄对乳酸清除率(lactate clearance rate,LCR)预测脓毒性休克患者预后价值的影响。方法:采用回顾性研究方法,选择2015年1月—2018年8月徐州医科大学附属医院ICU收治的资料完整的脓毒性休克患者为研究对象,按年龄分为非老年组(18~74岁)和老年组(≥75岁),再根据住院结局分为存活组和死亡组。记录患者确诊脓毒性休克时(0 h)、接受治疗后12 h和24 h的动脉血乳酸(lactate,Lac)水平,计算12 h LCR、24 h LCR;记录急性生理学与慢性健康状况评分Ⅱ(Acute Physiology and Chronic Health EvaluationⅡ,APACHEⅡ)评分、序贯器官衰竭估计(Sequential Organ Failure Assessment,SOFA)评分、住院天数及住院结局;统计分析各组患者上述指标的差异。结果:期间共483例脓毒性休克患者,其中286例患者符合入选标准,老年组111例、非老年组175例。老年组死亡61例(55.0%)、非老年组死亡55例(31.4%)。COX回归分析及生存时间曲线显示年龄是脓毒性休克患者预后的独立危险因素,老年组患者死亡风险是非老年组的1.95倍。不同年龄组的死亡组患者APACHEⅡ评分、SOFA评分、血Lac水平高于存活组,24 h LCR低于存活组,差异均有统计学意义(P<0.05);但老年死亡组患者12 h LCR与老年存活组比较差异并无统计学意义(P>0.05)。APACHEⅡ评分、SOFA评分及血Lac水平与住院病死率呈正相关,与LCR呈负相关。结论:年龄、APACHEⅡ评分、SOFA评分、Lac水平和LCR是住院结局的相关因素,其中年龄是脓毒性休克患者预后的独立危险因素,LCR无法准确评估老年脓毒性休克患者的预后。

Objective To explore the effects of age on the use of lactate clearance rate(LCR)to predict prognosis in septic shock patients.Methods Septic shock patients who were admitted into the intensive care unit(ICU)of the Affiliated Hospital of Xuzhou Medical University from January 2015 to August 2018,with complete clinical data,were selected for retrospective analysis.According to their ages,they were divided into a non‑elderly group(aged 18‒74 years)and an elderly group(≥75 years old).Moreover,according to the outcome of hospitalization,the patients were divided into a survival group and a death group.The level of arterial blood lactate(Lac)was measured when the patients were diagnosed with septic shock(0 h),and 12 h and 24 h after treatment,while the LCRs at 12 h and 24 h were calculated.The scores of Acute Physiology and Chronic Health EvaluationⅡ(APACHEⅡ)and Sequential Organ Failure Assessment(SOFA),the length of hospitalization stay and outcomes were recorded.The differences of above indicators in each group were analyzed.Results A total of 483 septic shock patients were collected,in which 286 patients met inclusion criteria,including 111 cases in the elderly group and 175 in the non‑elderly group.There were 61 cases(55.0%)of death in the elderly group and 55 cases(31.4%)of death in the non‑elderly group.The COX regression analysis and survival time curve showed that age was an independent risk factor for the prognosis of septic shock patients.The risk of death in the elderly group was 1.95 times higher than that in the non‑elderly group.Patients in the death group in different age ranges presented higher APACHEⅡscores,SOFA scores,and blood Lac levels as well as lower 24 h LCR than those in the survival group(P<0.05).However,no statistical difference was found as to 12 h LCR in elderly patients between the death group and the survival group(P>0.05).APACHEⅡscore,SOFA score and blood Lac level were positively related with hospitalization mortality,but negatively related with LCR.Conclusions Age,APACHEⅡscore,SOFA score,Lac level and LCR are related factors of hospitalization outcome,where age is an independent risk factor for the prognosis of septic shock patients.LCR cannot be used to accurately evaluate the prognosis of elderly patients with septic shock.