Background Early evaluation of prognosis in cardiogenic shock(CS)is crucial for tailored treatment selection.Both lactate clearance and lactate levels are considered useful prognostic biomarkers in patients with CS.Ho...Background Early evaluation of prognosis in cardiogenic shock(CS)is crucial for tailored treatment selection.Both lactate clearance and lactate levels are considered useful prognostic biomarkers in patients with CS.However,there is yet no literature comparing the 6-hour lactate clearance rate(Δ6Lac)with lactate levels measured at admission(L1)and after 6 h(L2)to predict 30-day mortality in CS.Methods In this observational cohort study,95 patients with CS were treated at Department of Intensive Care Unit,Yiwu Central Hospital between January 2020 and December 2022.Of these,88 patients met the eligibility criteria.The lactate levels were measured after admission(L1)as the baseline lactate value,and were measured after 6 h(L2)following admission.The primary endpoint of the study was survival rate at 30 days.A receiver operating characteristic curve was used for data analysis.Univariate and multivariate Cox regression analyses were performed based onΔ6Lac.Kaplan–Meier(KM)survival curves were generated to compare the 30-day survival rates among L1,L2,andΔ6Lac.Results TheΔ6Lac model showed the highest area under the curve value(0.839),followed by the L2(0.805)and L1(0.668)models.TheΔ6Lac model showed a sensitivity of 84.2%and specificity of 75.4%.The L1 and L2 models had sensitivities of 57.9%each and specificities of 89.9%and 98.6%,respectively.The cut-off values forΔ6Lac,L1,and L2 were 18.2%,6.7 mmol/L,and 6.1 mmol/L,respectively.Univariate Cox regression analysis revealed a significant association betweenΔ6Lac and 30-day mortality.After adjusting for five models in multivariate Cox regression,Δ6Lac remained a significant risk factor for 30-day mortality in patients with CS.In our fifth multivariate Cox regression model,Δ6Lac remained a risk factor associated with 30-day mortality(hazard ratio[HR]=5.14,95%confidence interval[CI]:1.48 to 17.89,P=0.010)as well as L2(HR=8.42,95%CI:1.26 to 56.22,P=0.028).The KM survival curve analysis revealed that L1>6.7 mmol/L(HR=8.08,95%CI:3.23 to 20.20,P<0.001),L2>6.1 mmol/L(HR=25.97,95%CI:9.76 to 69.15,P<0.001),andΔ6Lac≤18.2%(HR=8.92,95%CI:2.95 to 26.95,P<0.001)were associated with a higher risk of 30-day mortality.ConclusionsΔ6Lac is a better predictor for 30-day mortality in CS than lactate levels at admission.It has a predictive value equivalent to that of lactate level at 6 h after admission,making it an important surrogate indicator for evaluating the suitability as well as poor prognosis after CS treatment.We found that a cut-off value of 18.2%forΔ6Lac provided the most accurate assessment of early prognosis in CS.展开更多
目的 探讨心率判定脓毒症心肌病(SIC)病情及短期预后的临床价值。方法 选取2020-01-10-2022-01-10乳山市人民医院重症医学科(ICU)收治的128例SIC患者为研究对象,根据入院28 d预后将患者分为生存组和死亡组。比较2组患者入ICU时的基线资...目的 探讨心率判定脓毒症心肌病(SIC)病情及短期预后的临床价值。方法 选取2020-01-10-2022-01-10乳山市人民医院重症医学科(ICU)收治的128例SIC患者为研究对象,根据入院28 d预后将患者分为生存组和死亡组。比较2组患者入ICU时的基线资料、序贯器官衰竭评分(SOFA)、急性生理学与慢性健康状况评分Ⅱ(APACHEⅡ)、抗脓毒症集束化治疗6 h后乳酸清除率(6 h LCR)、入院时心率(HR1)和抗脓毒症集束化治疗6 h后心率(HR2)的差异;分析HR1和HR2与SOFA、APACHEⅡ、6 h LCR的相关性,并绘制受试者工作特征曲线(ROC),评估心率对SIC患者短期预后的应用价值。结果 128例患者中,生存组54例,占比42.2%;死亡组74例,占比57.8%。死亡组患者HR1、HR2、SOFA评分、APACHEⅡ均高于生存组,6 h LCR低于生存组,差异有统计学意义,均P<0.05。相关性分析结果显示,HR1、HR2与SOFA、APACHEⅡ呈正相关,与6 h LCR呈负相关,但HR2与SOFA、APACHEⅡ、6 h LCR的相关性更好。HR1、HR2的曲线下面积(AUC)分别为0.604、0.766,灵敏度分别为64.86%、82.43%,特异度分别为55.56%、57.41%,HR2较HR1灵敏度及特异度更高。结论 心率可作为SIC病情评估和短期预后的有效指标。展开更多
目的:评估血清肝素结合蛋白(HBP)水平联合24 h乳酸清除率(24 h LCR)对肺炎并发脓毒症患者预后判断的价值。方法:选取74例肺炎并发脓毒症患者,根据患者28 d预后分为存活组(51例)、死亡组(23例)。采用酶联免疫吸附(ELISA)法检测患者血清HB...目的:评估血清肝素结合蛋白(HBP)水平联合24 h乳酸清除率(24 h LCR)对肺炎并发脓毒症患者预后判断的价值。方法:选取74例肺炎并发脓毒症患者,根据患者28 d预后分为存活组(51例)、死亡组(23例)。采用酶联免疫吸附(ELISA)法检测患者血清HBP水平;采用血气分析仪检测患者体内血乳酸含量,并计算24 h LCR;采用Pearson法分析HBP水平、24 h LCR与急性生理与慢性健康评分(APACHEⅡ)的相关性;采用受试者工作特征(ROC)曲线评估HBP、24 h LCR对肺炎并发脓毒症患者的预后价值;采用COX回归分析影响肺炎并发脓毒症患者预后的因素。结果:①多因素分析显示,HBP高水平、24 h LCR低水平及APACHEⅡ评分是影响肺炎并发脓毒症患者不良预后的独立危险因素。②死亡组肺炎并发脓毒症患者HBP水平、APACHEⅡ评分明显高于存活组,24 h LCR水平明显低于存活组,差异有统计学意义(P<0.05);③肺炎并发脓毒症患者血清HBP水平与APACHEⅡ评分呈正相关,24 h LCR与APACHEⅡ评分呈负相关,差异有统计学意义(P<0.05)。④HBP预测肺炎并发脓毒症不良预后的曲线下面积(AUC)为0.874,截断值为22.89 ng/mL,其灵敏度、特异度分别为73.9%、92.2%;24 h LCR预测肺炎并发脓毒症不良预后的AUC为0.883,截断值为30.77%,其灵敏度、特异度分别为87.0%、80.4%;HBP联合24 h LCR预测肺炎并发脓毒症不良预后的AUC为0.932,其灵敏度、特异度分别为82.6%、98.0%;结论:死亡组肺炎并发脓毒症患者血清中HBP呈高水平,24 h LCR呈低水平,二者联合检测对肺炎并发脓毒症患者预后评估有一定参考价值。展开更多
目的:分析24小时乳酸清除率(24 h LCR)、序贯器官衰竭评分(SOFA评分)及简化急性生理评分(SAPSⅡ评分)在腹腔感染致脓毒症患者预后评估中的作用。方法:选择2014年3月~2015年9月我院收治的脓毒症患者37例,根据预后将患者分为两组,存活组(2...目的:分析24小时乳酸清除率(24 h LCR)、序贯器官衰竭评分(SOFA评分)及简化急性生理评分(SAPSⅡ评分)在腹腔感染致脓毒症患者预后评估中的作用。方法:选择2014年3月~2015年9月我院收治的脓毒症患者37例,根据预后将患者分为两组,存活组(28例)和死亡组(9例)。运用受试者工作特征曲线(ROC)比较24 h LCR、降钙素原(PCT)、SOFA评分、SAPSⅡ评分在腹腔感染致脓毒症患者预后评估中的效能并探讨它们之间的关系。结果:①死亡组患者PCT、SOFA评分及SAPSⅡ评分明显高于存活组患者,差异具有统计学意义;死亡组患者24 h LCR低于存活组患者,差异具有统计学意义。②24 h LCR、PCT、SOFA评分及SAPSⅡ评分在预测腹腔感染致脓毒症患者预后方面均有很大的价值,各指标ROC曲线下面积比较,差异均不具统计学意义。③24 h LCR与PCT呈负相关;SOFA评分与PCT呈正相关;SOFA评分与SAPSⅡ评分呈正相关。结论:24 h LCR、PCT、SOFA评分及SAPSⅡ评分在腹腔感染致脓毒症患者预后评估中具有重要意义。展开更多
基金supported by the Major(Key)Science and Technology Research Project of Jinhua(Grant No.2021-3-019).
文摘Background Early evaluation of prognosis in cardiogenic shock(CS)is crucial for tailored treatment selection.Both lactate clearance and lactate levels are considered useful prognostic biomarkers in patients with CS.However,there is yet no literature comparing the 6-hour lactate clearance rate(Δ6Lac)with lactate levels measured at admission(L1)and after 6 h(L2)to predict 30-day mortality in CS.Methods In this observational cohort study,95 patients with CS were treated at Department of Intensive Care Unit,Yiwu Central Hospital between January 2020 and December 2022.Of these,88 patients met the eligibility criteria.The lactate levels were measured after admission(L1)as the baseline lactate value,and were measured after 6 h(L2)following admission.The primary endpoint of the study was survival rate at 30 days.A receiver operating characteristic curve was used for data analysis.Univariate and multivariate Cox regression analyses were performed based onΔ6Lac.Kaplan–Meier(KM)survival curves were generated to compare the 30-day survival rates among L1,L2,andΔ6Lac.Results TheΔ6Lac model showed the highest area under the curve value(0.839),followed by the L2(0.805)and L1(0.668)models.TheΔ6Lac model showed a sensitivity of 84.2%and specificity of 75.4%.The L1 and L2 models had sensitivities of 57.9%each and specificities of 89.9%and 98.6%,respectively.The cut-off values forΔ6Lac,L1,and L2 were 18.2%,6.7 mmol/L,and 6.1 mmol/L,respectively.Univariate Cox regression analysis revealed a significant association betweenΔ6Lac and 30-day mortality.After adjusting for five models in multivariate Cox regression,Δ6Lac remained a significant risk factor for 30-day mortality in patients with CS.In our fifth multivariate Cox regression model,Δ6Lac remained a risk factor associated with 30-day mortality(hazard ratio[HR]=5.14,95%confidence interval[CI]:1.48 to 17.89,P=0.010)as well as L2(HR=8.42,95%CI:1.26 to 56.22,P=0.028).The KM survival curve analysis revealed that L1>6.7 mmol/L(HR=8.08,95%CI:3.23 to 20.20,P<0.001),L2>6.1 mmol/L(HR=25.97,95%CI:9.76 to 69.15,P<0.001),andΔ6Lac≤18.2%(HR=8.92,95%CI:2.95 to 26.95,P<0.001)were associated with a higher risk of 30-day mortality.ConclusionsΔ6Lac is a better predictor for 30-day mortality in CS than lactate levels at admission.It has a predictive value equivalent to that of lactate level at 6 h after admission,making it an important surrogate indicator for evaluating the suitability as well as poor prognosis after CS treatment.We found that a cut-off value of 18.2%forΔ6Lac provided the most accurate assessment of early prognosis in CS.
文摘目的 探讨心率判定脓毒症心肌病(SIC)病情及短期预后的临床价值。方法 选取2020-01-10-2022-01-10乳山市人民医院重症医学科(ICU)收治的128例SIC患者为研究对象,根据入院28 d预后将患者分为生存组和死亡组。比较2组患者入ICU时的基线资料、序贯器官衰竭评分(SOFA)、急性生理学与慢性健康状况评分Ⅱ(APACHEⅡ)、抗脓毒症集束化治疗6 h后乳酸清除率(6 h LCR)、入院时心率(HR1)和抗脓毒症集束化治疗6 h后心率(HR2)的差异;分析HR1和HR2与SOFA、APACHEⅡ、6 h LCR的相关性,并绘制受试者工作特征曲线(ROC),评估心率对SIC患者短期预后的应用价值。结果 128例患者中,生存组54例,占比42.2%;死亡组74例,占比57.8%。死亡组患者HR1、HR2、SOFA评分、APACHEⅡ均高于生存组,6 h LCR低于生存组,差异有统计学意义,均P<0.05。相关性分析结果显示,HR1、HR2与SOFA、APACHEⅡ呈正相关,与6 h LCR呈负相关,但HR2与SOFA、APACHEⅡ、6 h LCR的相关性更好。HR1、HR2的曲线下面积(AUC)分别为0.604、0.766,灵敏度分别为64.86%、82.43%,特异度分别为55.56%、57.41%,HR2较HR1灵敏度及特异度更高。结论 心率可作为SIC病情评估和短期预后的有效指标。
文摘目的:评估血清肝素结合蛋白(HBP)水平联合24 h乳酸清除率(24 h LCR)对肺炎并发脓毒症患者预后判断的价值。方法:选取74例肺炎并发脓毒症患者,根据患者28 d预后分为存活组(51例)、死亡组(23例)。采用酶联免疫吸附(ELISA)法检测患者血清HBP水平;采用血气分析仪检测患者体内血乳酸含量,并计算24 h LCR;采用Pearson法分析HBP水平、24 h LCR与急性生理与慢性健康评分(APACHEⅡ)的相关性;采用受试者工作特征(ROC)曲线评估HBP、24 h LCR对肺炎并发脓毒症患者的预后价值;采用COX回归分析影响肺炎并发脓毒症患者预后的因素。结果:①多因素分析显示,HBP高水平、24 h LCR低水平及APACHEⅡ评分是影响肺炎并发脓毒症患者不良预后的独立危险因素。②死亡组肺炎并发脓毒症患者HBP水平、APACHEⅡ评分明显高于存活组,24 h LCR水平明显低于存活组,差异有统计学意义(P<0.05);③肺炎并发脓毒症患者血清HBP水平与APACHEⅡ评分呈正相关,24 h LCR与APACHEⅡ评分呈负相关,差异有统计学意义(P<0.05)。④HBP预测肺炎并发脓毒症不良预后的曲线下面积(AUC)为0.874,截断值为22.89 ng/mL,其灵敏度、特异度分别为73.9%、92.2%;24 h LCR预测肺炎并发脓毒症不良预后的AUC为0.883,截断值为30.77%,其灵敏度、特异度分别为87.0%、80.4%;HBP联合24 h LCR预测肺炎并发脓毒症不良预后的AUC为0.932,其灵敏度、特异度分别为82.6%、98.0%;结论:死亡组肺炎并发脓毒症患者血清中HBP呈高水平,24 h LCR呈低水平,二者联合检测对肺炎并发脓毒症患者预后评估有一定参考价值。
文摘目的:分析24小时乳酸清除率(24 h LCR)、序贯器官衰竭评分(SOFA评分)及简化急性生理评分(SAPSⅡ评分)在腹腔感染致脓毒症患者预后评估中的作用。方法:选择2014年3月~2015年9月我院收治的脓毒症患者37例,根据预后将患者分为两组,存活组(28例)和死亡组(9例)。运用受试者工作特征曲线(ROC)比较24 h LCR、降钙素原(PCT)、SOFA评分、SAPSⅡ评分在腹腔感染致脓毒症患者预后评估中的效能并探讨它们之间的关系。结果:①死亡组患者PCT、SOFA评分及SAPSⅡ评分明显高于存活组患者,差异具有统计学意义;死亡组患者24 h LCR低于存活组患者,差异具有统计学意义。②24 h LCR、PCT、SOFA评分及SAPSⅡ评分在预测腹腔感染致脓毒症患者预后方面均有很大的价值,各指标ROC曲线下面积比较,差异均不具统计学意义。③24 h LCR与PCT呈负相关;SOFA评分与PCT呈正相关;SOFA评分与SAPSⅡ评分呈正相关。结论:24 h LCR、PCT、SOFA评分及SAPSⅡ评分在腹腔感染致脓毒症患者预后评估中具有重要意义。
