Prognosis evaluation of early lactate dynamic monitoring index in severe sepsis and septic shock patients
Abstract：Objective To evaluating the prognostic value of early lactate dynamic monitoring index in severe sepsis and septic shock patients.Methods One hundred and fifteen patients with sever sepsis and septic shock admitted from January 2011 to April 2013 in ICU,were enrolled in the study.All the patients were divided into 2 groups according to the treatment outcome:survival group and death group.Management of all patient in ICU was performed during the first 24h hospitalization.The general condition and clinical characteristics on arrival in ICU,the changes of CVP,MAP,lactate levels and /or lactate clearance rate before and after the beginning of fluid resuscitation and the other related parameters during the therapy were observed and recorded.The assessment value for death prediction of these indexes was evaluated by the area under ROC curve (AUC),and the factors of influencing patients’prognosis were analyzed by Logistic Regression.Results Two patients who gave up treatment within 24 hours were excepted from the study.Twenty-one patients died in the first 28 days.As compare with those in survival group,APACHEⅡscores and SOFA scores in death group were increased,length of stay in hospital was prolonged,lactate concentration was obviously increased at 24h after beginning of fluid resuscitation,lactate clearance rate was decreased at 12 h,24 h after beginning of fluid resuscitation in death group(P <0.05 ).At 24h after beginning of fluid resuscitation,the area under ROC curve was the largest (AUC =0.78,95%CI:0.56 ~0.82),at different time points ScvO2 ,ScvO2 variation-related area under ROC curve was less,which suggested its accuracy for predicting patients’ 28-day prognosis was poor.Logistic regression analysis showed that the lactate clearance rate at 24h after beginning of fluid resuscitation and APACHE Ⅱ scores were the independent risk factors for patients’ survival.Conclusion The lactate clearance rate within the first 24h in ICU is closely correlated to the prognosis of patients with sepsis,with the best evaluation value for patients’prognosis,even over the first 6h in ICU,lactate clearance rate is also the most significant index for instructing therapy in patients with sepsis.
Keywords：lactic acidlactic acid clearance rateScvO2severe sepsissepsis shockliquid resuscitationprognosis
Publication Date：2015-01-01
Online Publishing Date：2025-08-15(First online date of this platform, not the publication date of the document)
Pages：5( 1449-1453 )