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首页> 外文期刊>Journal of Intensive Care >Prognostic utility of plasma lactate measured between 24 and 48?h after initiation of early goal-directed therapy in the management of sepsis, severe sepsis, and septic shock
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Prognostic utility of plasma lactate measured between 24 and 48?h after initiation of early goal-directed therapy in the management of sepsis, severe sepsis, and septic shock

机译：在开始早期目标导向治疗后的24至48小时内测量血浆乳酸对脓毒症，严重脓毒症和脓毒性休克的治疗的预后效用

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BackgroundBased on the proven efficacy of lactate in predicting mortality and morbidity in sepsis when measured early in the resuscitative protocol, our group hypothesized that this utility extends later in the course of care. This study sought to investigate the prognostic potential of plasma lactate clearance measured 24–48 h after the initiation of treatment for nonsurgical patients with sepsis, severe sepsis, and septic shock. MethodsPlasma lactate values, measured 24–48 h after the initiation of treatment, were collected in nonsurgical septic, severe septic, and septic shock patients. The primary outcome was 30-day mortality, while secondary outcomes included requirements for vasopressors and boluses of intravenous fluids. Analysis of these three outcomes was performed while controlling for clinical severity as measured by Sequential Organ Failure Assessment (SOFA), renal dysfunction, and hepatic dysfunction. Lactate clearance was defined as the percent change in plasma lactate levels measured after 24–48 h of treatment from the plasma lactate level at initial presentation. ResultsTwo hundred twenty-nine nonsurgical patients were divided into two groups, clearers (above median lactate clearance [31.6 %]) and nonclearers (below median lactate clearance [31.6 %]). The adjusted odds ratio of mortality in clearers compared to nonclearers was 0.39 (CI 0.20–0.76) (p = 0.006). For vasopressor requirement, the adjusted odds ratio was 0.41 (CI 0.21–0.79) in clearers compared to nonclearers (p = 0.008). For intravenous fluid bolus requirement, the adjusted odds ratio was 0.81 (CI 0.48–1.39) in clearers compared to nonclearers (p = 0.45). ConclusionsLower plasma lactate clearance 24–48 h after the initiation of treatment is associated with higher 30-day mortality and requirements for vasopressors in nonsurgical septic patients and may be a useful noninvasive measurement for guiding late-sepsis treatment. Further investigation looking at mechanisms and therapeutic targets to improve lactate clearance in late sepsis may improve patient mortality and outcomes.
机译：背景基于在复苏方案中早期进行测定时，基于乳酸在预测脓毒症死亡率和发病率方面已被证实的功效，我们的研究小组推测这种效用在护理过程中会有所扩展。这项研究旨在探讨对于非手术败血症，严重脓毒症和败血性休克的非手术患者，在治疗开始后24-48小时测量血浆乳酸清除率的预后潜力。方法在非手术脓毒症，重度脓毒症和脓毒性休克患者中，收集开始治疗后24-48小时测量的血浆乳酸值。主要结局为30天死亡率，而次要结局包括需要使用血管加压药和静脉注注大剂量。在控制临床严重程度的同时对这三个结果进行了分析，如通过顺序器官衰竭评估（SOFA），肾功能不全和肝功能不全所测量的。乳酸清除率定义为治疗24-48小时后血浆乳酸水平相对于最初出现时血浆乳酸水平的百分比变化。结果229例非手术患者分为两组，清洁剂（乳酸清除率中位数以上[31.6％]）和非清洁剂（乳酸清除率中位数以下[31.6％]）。与非清算人相比，清算人死亡率调整后的优势比为0.39（CI 0.20–0.76）（p = 0.006）。对于升压药的需求，与非清洁剂相比，清洁剂的调整后优势比为0.41（CI 0.21-0.79）（p = 0.008）。对于静脉输液药量要求，与非清洁剂相比，清洁剂的校正比值比为0.81（CI 0.48-1.39）（p = 0.45）。结论治疗开始后24–48 h血浆乳酸清除率降低与30天内较高的死亡率以及非手术脓毒症患者对升压药的需求有关，这可能是指导晚期脓毒症治疗的一种有用的无创测量方法。进一步研究寻找改善败血症晚期乳酸清除率的机制和治疗目标可能会提高患者的死亡率和结局。

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