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目的既往的研究表明,乳酸水平高于2 mmol/L与预后不良相关,但目前还不清楚当乳酸水平在正常范围内升高对预后的影响。本研究拟比较存活组与死亡组乳酸水平的差异,从而明确乳酸相对增高与死亡率的关系,同时寻找提示预后不良的最佳乳酸值。方法采用回顾性分析,研究对象为107例脓毒症患者,所有患者入院时血乳酸水平均波动在0.5~2.0 mmol/L范围。首先根据患者住院期间临床结局将患者分为存活与死亡2组,采用独立样本t检验明确两者乳酸水平是否有统计学差异。用ROC曲线寻找预测患者死亡率的最佳乳酸值,进一步根据该值将患者分为高、低乳酸血症2组,再比较2组患者死亡率是否有统计学差异。结果 107例患者中32例死亡75例存活。存活组患者血浆乳酸平均值为(0.8347±0.2310)mmol/L,而死亡组为(1.2188±0.3881),t=14.377,P<0.001,乳酸水平大于1.15 mmol/L时预测患者死亡率的敏感性为59.4%,特异性为90.7%(AUC=0.79,P<0.001,95%CI=0.687~0.893)。高乳酸血症组患者26例,死亡19例,低乳酸血症患者81例,死亡13例,差异有统计学意义(P<0.001)。结论入院时患者乳酸水平即使轻度升高(1.16~2.00mmol/L)也与脓毒症患者死亡率增高相关。当乳酸水平大于1.15 mmol/L时提示患者预后不良。
PURPOSE Previous studies have shown that lactate levels above 2 mmol / L are associated with poor prognosis, but it is unclear how the elevated lactate levels will affect prognosis in the normal range. This study intended to compare the differences in lactic acid levels between survivors and deaths to determine the relationship between relative increase in lactic acid and mortality and to find the optimal lactic acid value that suggests a poor prognosis. Methods The retrospective analysis of 107 patients with sepsis, all patients with blood lactic acid fluctuations in the range of 0.5 ~ 2.0 mmol / L range. First, patients were divided into two groups based on the clinical outcome of hospitalization: survival and death, using independent samples t test to determine whether there is a statistically significant difference between the two levels of lactic acid. The ROC curve was used to find the optimal lactate value to predict the mortality of patients. Based on this value, the patients were divided into two groups: high and low lactatemia, and then the mortality of two groups were compared statistically. Results Of the 107 patients, 32 died and 75 survived. The mean plasma lactate level in survivors was (0.8347 ± 0.2310) mmol / L, while the death group was (1.2188 ± 0.3881), t = 14.377, P <0.001, and the lactate level was greater than 1.15 mmol / L Was 59.4% with a specificity of 90.7% (AUC = 0.79, P <0.001, 95% CI = 0.687-0.893). There were 26 patients with hyperlactia, 19 patients died, 81 patients had low lactatemia and 13 died. The difference was statistically significant (P <0.001). Conclusions Even mild elevation of lactate levels (1.16-2.00 mmol / L) on admission may be associated with an increased mortality rate in sepsis patients. When the lactate level is greater than 1.15 mmol / L, suggesting that patients with poor prognosis.