乳酸与48 h乳酸清除率对脓毒症患者预后的预测价值

Prognostic value of lactic acid and 48-hour lactate clearance rate in patients with sepsis

目的探讨乳酸、48 h乳酸清除率对脓毒症患者预后的预测价值,并构建预测模型。方法收集2015年6月至2017年12月复旦大学附属中山医院急诊重症监护室202例脓毒症患者的临床资料。根据90 d生存情况将患者分成存活组(n=142)和死亡组(n=60),比较两组患者一般资料、乳酸、48 h乳酸清除率、C反应蛋白(CRP)、降钙素原(PCT)、序贯器官衰竭(SOFA)评分、急性生理学与慢性健康状况Ⅱ(APACHEⅡ)评分、合并症等指标。多因素分析脓毒症患者死亡的危险因素,并建立脓毒症预后预测的Nomogram模型。采用受试者工作特征(ROC)曲线、曲线下面积(AUC)对模型的诊断效能进行评价。结果202例脓毒症患者中,90 d死亡的共60例。死亡组患者入院时的PCT、CRP、乳酸、SOFA评分及APACHEⅡ评分显著高于存活组患者,48 h乳酸清除率显著低于存活组患者(均P<0.001)。多因素logistic回归分析显示:APACHEⅡ评分(OR=1.091,P=0.011)、乳酸(OR=1.589,P<0.01)是脓毒症患者死亡的危险因素;48 h乳酸清除率(OR=0.622,P=0.021)是脓毒症患者死亡的保护因素。联合APACHEⅡ评分、乳酸、48 h乳酸清除率构建的Nomogram预测模型,AUC为0.868,灵敏度为71.2%,特异度为88.1%,明显优于其他单项指标对于预后的评估。结论乳酸、APACHEⅡ、48 h乳酸清除率是脓毒症患者90 d死亡的影响因素,由上述指标构建的模型可以用于预测脓毒症患者预后。

Objective To explore the prognostic value of lactic acid and 48-hour lactate clearance rate in patients with sepsis and to establish a predictive model.Methods From June 2015 to December 2017,202 patients with sepsis in the emergency intensive care unit of Zhongshan Hospital,Fudan University were collected.The patients were divided into survival group(n=142)and death group(n=60)according to 90-day survival.The general data,lactic acid,48-hour lactate clearance rate,CRP,PCT,SOFA score,APACHEⅡscore and comorbidities were compared between the two groups.The risk factors of death in patients with sepsis were analyzed by multivariate analysis,and Nomogram model of predicting the prognosis of sepsis was established.The diagnostic efficacy of the model was evaluated by ROC curve and AUC.Results Compared with the survival group,PCT,CRP,lactic acid,SOFA score,and APACHEⅡscore at admission were significantly higher in death group,while the 48-hour lactate clearance rate in the death group was significantly lower than that in the survival group(all P<0.001).Multivariate logistic regression analysis showed that APACHEⅡscore(OR=1.091,P=0.011)and lactic acid(OR=1.589,P<0.01)were risk factors for 90-day death in patients with sepsis,and 48-hour lactate clearance rate was a protective factor(OR=0.622,P=0.021).The Nomogram model combined with 48-hour lactate clearance rate,APACHEⅡscore and lactic acid showed that the area under the ROC curve was 0.868,the sensitivity was 71.2%and the specificity was 88.1%,which was significantly better than that of other individual indicators for the evaluation of prognosis.Conclusions Lactic acid,APACHEⅡscore and 48-hour lactate clearance rate are influencing factors for 90-day death in patients with sepsis.The model constructed by above indicators can be used to predict the prognosis of patients with sepsis.