APACHEⅡ评分联合动脉血乳酸水平对危重症产妇预后的预测价值分析

摘要 目的：探讨急性生理学与慢性健康状况评分系统Ⅱ（APACHEⅡ）评分联合动脉血乳酸水平对危重症产妇预后的预测价值。方法：选取2019年3月至2022年3月期间上海市第一妇婴保健院收治的危重症产妇84例,根据住院期间危重症产妇的生存预后情况将其分为预后良好组（n=74）及预后不良组（n=10）。所有纳入本研究的危重症产妇均于入院24 h内完成APACHEⅡ评分评估;对所有危重症产妇应用动脉血气分析仪测定其动脉血乳酸水平。对比两组危重症产妇APACHEⅡ评分及动脉血乳酸水平;采用Pearson相关系数分析危重症产妇APACHEⅡ评分与其动脉血乳酸水平的相关性;单因素、多因素Logistic回归分析危重症产妇预后不良的危险因素;采用受试者工作特征（ROC）曲线分析APACHEⅡ评分、动脉血乳酸水平单项指标及联合检测对危重症产妇预后的预测效能。结果：预后不良组APACHEⅡ评分、动脉血乳酸水平均高于于预后良好组（P＜0.05）。采用Pearson相关系数分析显示,危重症产妇APACHEⅡ评分与其动脉血乳酸水平呈正相关（P＜0.05）。多因素Logistic回归分析显示年龄≥35岁、孕前体质指数（BMI）≥25 kg/m²、剖宫产、产后并发心力衰竭、高APACHEⅡ评分、动脉血乳酸水平升高是危重症产妇预后不良的危险因素（P＜0.05）。ROC曲线分析显示,APACHEⅡ评分、动脉血乳酸水平联合检测的预测效能高于单项指标检测。结论：危重症产妇动脉血乳酸水平随着APACHEⅡ评分升高而升高,两者呈正相关关系。高APACHEⅡ评分、动脉血乳酸水平升高是影响危重症产妇预后不良的危险因素,联合检测上述两项指标对危重症产妇预后的预测价值较高。     

心脏外科术后重症患者死亡影响因素的Logistic回归分析及对预后的预测价值

摘要 目的：探讨心脏外科术后重症患者死亡的影响因素并分析其对预后的预测价值。方法：回顾性分析2016年3月至2021年6月本院重症监护室（ICU）收治的108例心脏外科术后重症患者的临床资料,根据出院前临床结局分为死亡组及存活组,比较两组临床指标的差异,采用Logistic回归分析患者死亡的危险因素,绘制受试者特征工作曲线（ROC）分析危险因素对预后的预测价值。结果：108例患者存活组80例,死亡组28例;死亡组房颤史比例、Killip心功能分级≧III级比例、左室射血分数（LVEF）<40%比例、血管活性药物输注比例、急性生理学与慢性健康状况评分II（APACHEII）、心肌肌钙蛋白I（cTnI）、血肌酐（Scr）、B型钠尿肽（BNP）高于存活组,肾小球滤过率（eGFR）低于存活组,差异有统计学意义（P<0.05）;多因素Logistic回归分析显示,APACHEII评分、eGFR、cTnI是心脏外科术后重症患者死亡的独立危险因素（P<0.05）;ROC曲线显示,APACHEII评分、eGFR、cTnI预测心脏外科术后重症患者预后的曲线下面积分别为0.836、0.799、0.710,三者联合预测曲线下面积为0.862。结论：APACHEII评分、eGFR、cTnI是心脏外科术后重症患者预后的独立危险因素,三者联合用于预后的预测价值更高,可为临床治疗提供一定参考。     

APACHEIV和APACHEII预测危重症患者预后的比较性研究

目的：比较不同版本的急性生理和慢性健康评分（Acute Physiology And Chronic Health Evaluation,APACHE）（APACHEⅣ和APACHEⅡ）对于成人危重症患者预后评估的应用价值。方法：收集2011年1月至10月入住我院重症监护病房患者的临床资料,分别计算其入ICU24小时内的APACHEⅣ和APACHEII评分,并计算其各自预测病死率,通过标准化死亡率（Standardized Mortality Ratios,SMR）来比较这两个评分系统对危重症患者预后评估的准确性。结果：本研究共纳入184例患者,死亡率为41．8％。APACHEII得分为25±8分,预测死亡率为53．31％;APACHEⅣ得分为93±24分,预测死亡率为30．76％。APACHEII预测死亡率比实际死亡率高（SMR为0．78,95％CI0．614-0．972）;APACHEIV预测死亡率比实际死亡率低（SMR=1.35,95％CI1．066-1．688）。但二者对于危重症患者死亡率的预测没有统计学差异（P〉0．05）。结论：APACHEII和APACHEIV对于危重症患者死亡率预测准确性高;与APACHEII相比,APACHEIV无表现出更为优越的性能,二者之间的差异不存在统计学意义。     

qSOFA评分、血乳酸及红细胞分布宽度与急性上消化道出血病情严重程度的关系及其预测患者预后的效能分析

摘要 目的：探讨快速序贯器官功能衰竭评估（qSOFA）评分、血乳酸（Lac）及红细胞分布宽度（RDW）与急性上消化道出血（AUGIB）病情严重程度的关系及其预测患者预后的效能。方法：选取2017年6月～2022年6月我院收治的230例AUGIB患者为研究对象,根据病情严重程度分为低危组44例、中危组140例、高危组36例、极高危组10例,且根据其入院28 d内生存情况分为死亡组（n=31）和存活组（n=199）。收集AUGIB患者临床资料,检测血Lac、RDW水平并计算qSOFA评分。采用多因素Logistic回归分析AUGIB患者预后不良的影响因素,受试者工作特征（ROC）曲线分析qSOFA评分和血Lac、RDW对AUGIB患者预后不良的预测价值。结果：低危组、中危组、高危组、极高危组qSOFA评分和血Lac、RDW水平依次升高（P＜0.05）。230例AUGIB患者入院28 d内死亡率为13.48％（31/230）。多因素Logistic回归分析显示,年龄增加、GBS评分≥6分及休克指数、qSOFA评分、血尿素氮、血Lac、RDW水平升高为AUGIB患者预后不良的独立危险因素（P＜0.05）。ROC曲线分析显示,qSOFA评分、血Lac及RDW联合预测AUGIB患者预后不良的曲线下面积大于qSOFA评分、血Lac及RDW单独预测。结论：AUGIB患者qSOFA评分、血Lac及RDW水平升高与病情加重和预后不良密切相关,qSOFA评分、血Lac及RDW联合预测AUGIB患者预后不良的效能较高。     

探讨NTIS 在ICU 重症患者的预后影响

目的:观察NTIS在ICU重症患者中的发病情况,及对病情的预后。方法:2010年1月到2010年3月,收集上海交通大学附属第六人民医院重症监护病房ICU收治的患者共161例。根据甲状腺功能情况分组。记录其年龄、性别、血糖、血白蛋白、肝肾功能、电解质、白细胞、血气、心率、血压等,统计有创呼吸机的使用率、使用天数、APACHEII评分、ICU住院天数和住院期间的死亡率,分析相关的影响因素。结果:161例入住ICU的重症患者中74例伴有NTIS(45.96%),血清游离三碘甲状腺原氨酸(FT3)水平是ICU住院时间的独立影响因素,低T3与住院期间死亡率明显相关,是主要死亡危险因子;NTIS患者较正常甲状腺患者死亡风险增加2.93倍(95%CI,1.052～8.182)。结论:低T3在重症疾病患者中发病常见,与住院期间死亡率明显相关,对于预测患者病情的严重程度和预后有重要的价值。     

血乳酸水平动态监测在危重症患者的应用的临床价值分析

目的:探讨动态监测动脉乳酸水平对危重患者的应用的临床价值分析。方法:对2010年2月~2011年6月间收治的危重病患者的血乳酸水平进行动态监测,通过比较死亡组患者和存活组患者乳酸水平及其它临床指标,比较不同乳酸水平组患者的临床资料来分析乳酸在危重症患者的应用价值。结果:死亡组和存活组患者在性别、年龄差异无明显的统计学意义(P>0.05);病死组乳酸水平、APACHEⅡ评分、住ICU时间(天)、机械通气时间明显高于生存组,差异有显著的统计学意义(P<0.01);严重乳酸酸中毒组患者在APACHEⅡ评分、休克发生率、MODS发生率、死亡发生率均明显高于乳酸酸中毒组和高乳酸血症组,差异有明显的统计学意义(P<0.05),乳酸酸中毒组休克发生率、MODS发生率、死亡发生率均明显高于高乳酸血症组,差异有明显的统计学意义(P<0.05)。结论:动态监测动脉乳酸水平是判断危重患者预后的一个良好指标,动脉乳酸越高,预后差。     

衰弱与老年呼吸衰竭患者预后的关系及对死亡风险的预测价值研究

摘要 目的：探讨衰弱与老年I型、II型呼吸衰竭患者预后的关系及对死亡风险的预测价值。方法：回顾性分析224例因呼吸衰竭入住首都医科大学附属北京同仁医院呼吸与危重症医学科的老年患者的临床资料,根据衰弱量表评分将患者分为轻度衰弱组（衰弱量表评分≤5分）、中度衰弱组（衰弱量表评分为6分）和重度衰弱组（衰弱量表评分为7分）。对比老年I型、II型呼吸衰竭患者不同衰弱程度的临床资料,采用多元Logistic回归分析预后的危险因素,采用受试者工作特征（ROC）曲线下面积（AUC）分析衰弱量表评分联合其他指标对患者死亡风险的预测能力。结果：I型呼吸衰竭入院的不同衰弱程度组老年患者的死亡率比较未见统计学差异（P>0.05）;II型呼吸衰竭入院的重度衰弱组老年患者的死亡率高于轻度衰弱组和中度衰弱组（P<0.05）;多元Logistic回归分析结果显示：年龄、血乳酸、急性生理和慢性健康状况评分II（APACHE II）评分是影响老年I型呼吸衰竭患者死亡的独立危险因素（P<0.05）;衰弱量表评分、年龄、APACHE II评分及血乳酸水平均为老年II型呼吸衰竭患者死亡的独立危险因素（P<0.05）。衰弱量表评分联合年龄、APACHE II评分、血乳酸预测老年II型呼吸衰竭患者死亡风险的AUC大于衰弱量表评分、年龄、APACHE II评分、血乳酸单独预测。结论：衰弱与老年I型呼吸衰竭患者预后无关,衰弱是老年II型呼吸衰竭患者发生死亡事件的独立危险因素,对老年II型呼吸衰竭进行衰弱量表评分可辅助评估患者预后。     

探讨NTIS在ICU重症患者的预后影响

目的：观察NTIS在ICU重症患者中的发病情况,及对病情的预后。方法：2010年1月到2010年3月,收集上海交通大学附属第六人民医院重症监护病房ICU收治的患者共161例。根据甲状腺功能情况分组。记录其年龄、性别、血糖、血白蛋白、肝肾功能、电解质、白细胞、血气、心率、血压等,统计有创呼吸机的使用率、使用天数、APACHEII评分、ICU住院天数和住院期间的死亡率,分析相关的影响因素。结果：161例入住ICU的重症患者中74例伴有NTIS（45.96%）,血清游离三碘甲状腺原氨酸（FT3）水平是ICU住院时间的独立影响因素,低T3与住院期间死亡率明显相关,是主要死亡危险因子;NTIS患者较正常甲状腺患者死亡风险增加2.93倍（95%CI,1.052～8.182）。结论：低T3在重症疾病患者中发病常见,与住院期间死亡率明显相关,对于预测患者病情的严重程度和预后有重要的价值。     

老年患者术后脓毒血症预后影响因素分析

目的 探讨发病原因及感染等因素对老年患者术后发生脓毒血症病情及预后的评估价值。方法 收集2019年1月—2021年11月外科重症监护室术后发生脓毒血症的老年患者92例,以生存结局分为死亡组和存活组,通过比较两组患者术前、术后身体质量指数（BMI）、血清总蛋白（TP）、白蛋白（Alb）、C-反应蛋白（CRP）、降钙素原（PCT）、B型利钠肽（BNP）、乳酸和D-二聚体（D-D）等指标差异,采用多因素logistic回归分析分析影响术后脓毒血症预后的危险因素,并绘制受试者工作特征曲线（ROC）,计算ROC曲线下面积（AUC）。结果 两组老年患者合并的基础疾病中,消化系统疾病引发脓毒血症的死亡率高于其他系统疾病（P<0.05）。存活组与死亡组术前血清TP、Alb、CRP、PCT、BNP、乳酸和D-D与术后比较差异无统计学意义（P>0.05）。术后存活组与死亡组比较,血清乳酸、Alb、PCT、D-D和BNP差异均有统计学意义（P> 0.05）。多因素回归分析发现乳酸和BNP是影响术后脓毒血症死亡的危险因素,AUC分别为0.879和0.858。结论 血清乳酸和BNP与老年术后发...     

小儿脓毒性休克早期血乳酸浓度与病情严重程度的相关性分析

目的:探讨早期动态监测血乳酸浓度对评价小儿脓毒性休克病情严重程度与预后的价值。方法:入选90例小儿脓毒性休克患儿,以诊断休克为研究起点,动态监测研究0 h、6 h的血乳酸,计算6 h乳酸清除率。按PCIS评分分为≥70分组(n=41)、60~70分组(n=40)、60分组(n=9);按预后分为存活组(n=62)与死亡组(n=28);按乳酸清除率分为高乳酸清除率组(n=57)与低乳酸清除率组(n=33),对各组PCIS评分、0 h血乳酸及乳酸清除率等指标进行比较。结果:≥70分组、60~70分组、60分组0 h血乳酸及乳酸清除率比较差异有计学意义(P0.05),≥70分组明显低于60~70分组及60分组,60~70分组明显低于60分组(P均0.05);存活组PCIS评分及乳酸清除率显著高于死亡组,0 h血乳酸水平明显低于死亡组(P0.05);高乳酸清除率组PCIS评分显著高于低乳酸清除率组。PCIS评分与0 h血乳酸浓度呈显著负相关(r=-0.619,P0.05),与乳酸清除率呈显著正相关(r=-0.702,P0.05)。结论:在评价小儿脓毒性休克的病情严重程度及预后方面,早期血乳酸清除率比单次血乳酸浓度更有意义。     

Blood Lactate/ATP Ratio,as an Alarm Index and Real-Time Biomarker in Critical Illness

Objective

The acute physiology, age and chronic health evaluation (APACHE) II score and other related scores have been used for evaluation of illness severity in the intensive care unit (ICU), but there is still a need for real-time and sensitive prognostic biomarkers. Recently, alarmins from damaged tissues have been reported as alarm-signaling molecules. Although ATP is a member of the alarmins and its depletion in tissues closely correlates with multiple-organ failure, blood ATP level has not been evaluated in critical illness. To identify real-time prognostic biomarker of critical illness, we measured blood ATP levels and the lactate/ATP ratio (ATP-lactate energy risk score, A-LES) in critically ill patients.

Methods and Results

Blood samples were collected from 42 consecutive critically ill ICU patients and 155 healthy subjects. The prognostic values of blood ATP levels and A-LES were compared with APACHE II score. The mean ATP level (SD) in healthy subjects was 0.62 (0.19) mM with no significant age or gender differences. The median ATP level in severely ill patients at ICU admission was significantly low at 0.31 mM (interquartile range 0.25 to 0.44) than the level in moderately ill patient at 0.56 mM (0.38 to 0.70) (P<0.01). Assessment with ATP was further corrected by lactate and expressed as A-LES. The median A-LES was 2.7 (2.1 to 3.3) in patients with satisfactory outcome at discharge but was significantly higher in non-survivors at 38.9 (21.0 to 67.9) (P<0.01). Receiver operating characteristic analysis indicated that measurement of blood ATP and A-LES at ICU admission are as useful as APACHE II score for prediction of mortality.

Conclusion

Blood ATP levels and A-LES are sensitive prognostic biomarkers of mortality at ICU admission. In addition, A-LES provided further real-time evaluation score of illness severity during ICU stay particularly for critically ill patients with APACHE II scores of ≥20.0.     

尿蛋白定性与ICU 危重患者预后的相关性研究

目的:探讨尿蛋白定性结果在ICU危重症患者病情和预后的预测价值。方法:对2008年1月～2011年5月我院ICU收治的190例患者,按照尿蛋白定性分为尿蛋白阴性组和尿蛋白定性阳性组,分别比较两组患者的肾功能不全、多器官功能衰竭、病死率及APACHE II评分,并进一步分析尿蛋白含量与上述指标的关系。结果:190例患者尿蛋白定性为阳性的为124例患者,阴性的66例患者,经过比较发现ARF发生率、MODS发生率、病死率,APACHE II评分,阳性组患者均明显高于阴性组患者,差异有显著的统计学意义(P<0.01);并且经过比较发现ARF发生率、MODS发生率、病死率,APACHE II评分不同组尿蛋白阳性组之间差异有显著的统计学意义(P<0.01),随着尿蛋白+的增加,ARF发生率、MODS发生率、病死率、APACHE II评分逐渐增加。结论:尿蛋白定性能很好的预测ICU危重患者肾功能不全、多器官功能衰竭和死亡的发生,反应患者病情的严重程度。     

血浆D-二聚体、CRP及血乳酸在急诊创伤性休克患者中的表达及临床意义

目的:探讨血浆D-二聚体、C反应蛋白(CRP)及血乳酸在急诊创伤性休克患者中的表达及临床意义。方法:选取2015年2月到2017年9月期间在我院接受治疗的创伤性休克患者186例,根据患者的最终结局分为存活组和死亡组,其中在病情平稳后转出重症监护室的作为存活组(106例),死亡的患者作为死亡组(80例)。比较两组患者的急性生理学与慢性健康状况评分Ⅱ(APACHEⅡ)评分,并比较两组患者在入院时、入院后12h、入院后24h的血浆D-二聚体、C反应蛋白(CRP)及血乳酸水平,分析血浆D-二聚体、CRP及血乳酸水平与APACHEⅡ评分的相关性。结果:死亡组的APACHEⅡ评分显著高于存活组,差异具有统计学意义(P0.05);两组的D-二聚体、CRP水平均随着时间的推移逐渐升高,血乳酸水平逐渐降低,差异具有统计学意义(P0.05);存活组患者的D-二聚体、CRP、血乳酸水平在各个时间点均低于死亡组,差异具有统计学意义(P0.05)。急诊创伤性休克患者血浆D-二聚体、CRP及血乳酸水平与APACHEⅡ评分均呈正相关(r=0.564、0.676、0.506,P0.05)。结论:血浆D-二聚体、CRP及血乳酸水平与急诊创伤性休克患者的APACHEⅡ评分存在相关性,临床上可对其进行检测来评估患者的病情和预后情况。     

ISS与APACHEⅡ评分对急诊多发伤患者伤情评估的价值分析

目的:探讨损伤严重程度计分法(Injuryseverityscore,ISS)和慢性健康评分(Acute physiology and chronic health evaluation scoreⅡ,APACHEⅡ)评分对急诊多发伤患者伤情评估的应用价值。方法:将我院自2016年6月至2019年6月急诊收治的多发伤患者85例作为研究对象,分别使用ISS和APACHEⅡ评分,追踪患者住院期间的伤情严重程度和预后情况。结果:急诊多发伤患者入院时ISS评分和APACHEⅡ评分越高,患者ICU收住率和死亡率越高,患者预后越差(P0.05);死亡的急诊多发伤患者ISS评分和APACHE-Ⅱ评分均明显高于存活组(P0.05)。ISS评分预测急诊多发伤患者死亡的灵敏度为87.06%,特异性为85.88%,APACHE-Ⅱ评分预测急诊多发伤患者死亡的灵敏度和特异性分别为88.24%和87.06%,差异无统计学意义(P0.05),两者联合预测急诊多发伤患者死亡的灵敏度为95.29%,特异性为94.12%,均优于单独预测(P0.05)。结论:ISS评分和APACHE-Ⅱ评分能够较为准确的评估急诊多发伤患者的病情严重程度,对患者预后具有较好的预测价值,两者结合使用的应用价值更高。     

脓毒症患者炎性因子、凝血功能与APACHEⅡ评分和预后的关系

目的:研究脓毒症患者炎性因子、凝血功能与急性生理学和慢性健康状况Ⅱ(APACHEⅡ)评分和预后的关系。方法:选取2017年1月至2018年1月我院收治的脓毒症患者150例为脓毒症组,所有患者根据预后结果分为死亡组(n=49)和存活组(n=101),选择同期在我院住院的非脓毒症患者98例为非脓毒症组,比较脓毒症组与非脓毒症组患者炎性因子、凝血功能指标水平及APACHEⅡ评分,同时比较死亡组和存活组患者炎性因子、凝血功能指标水平及APACHEⅡ评分,并分析脓毒症患者APACHEⅡ评分与炎性因子、凝血功能指标的相关性。结果:脓毒症组患者降钙素原(PCT)、活化部分凝血酶原时间(APTT)、凝血酶原时间(PT)水平及APACHEⅡ评分均高于非脓毒症组,血小板计数(PLT)低于非脓毒症组(P0.05),两组C-反应蛋白(CRP)比较差异无统计学意义(P0.05)。死亡组患者PCT、APTT、PT水平及APACHEⅡ评分均高于存活组,PLT水平低于存活组(P0.05),两组CRP比较差异无统计学意义(P0.05)。经Spearman相关性分析结果显示,脓毒症患者APACHEⅡ评分与PCT、APTT、PT均呈正相关关系,与PLT呈负相关关系(P0.05),与CRP无相关性(P0.05)。结论:脓毒症患者PCT、APTT、PT水平明显上升,PLT水平明显下降,且均与患者的APACHEⅡ评分密切相关,临床可通过调节炎症因子水平及凝血功能指标从而改善患者的病情和预后。     

Prognosis of patients receiving intensive care for lifethreatening medical complications of haematological malignancy

The mortality of patients admitted to intensive care units with haematological malignancy is high. A humane approach to the management of the critically ill as well as efficient use of limited resources requires careful selection of those patients who are most likely to benefit from intensive care. To delineate more accurately the factors influencing outcome in these patients the records of 60 consecutive admissions to the intensive care unit (37 male, 23 female) with haematological malignancy were reviewed retrospectively. Fifty patients were in acute respiratory failure, most commonly (34 patients) with a combination of pneumonia and septicaemic shock. The severity of the acute illness was assessed by the APACHE II (acute physiology and chronic health evaluation II) score and number of organ systems affected. Thirteen patients survived to leave hospital. The mortality of patients with haematological malignancy was consistently higher than predicted from a large validation study of APACHE II in a mixed population of critically ill patients. Moreover, no patient with an APACHE II score of greater than 26 survived. Mortality among the 22 patients with relapsed malignancy (21 deaths), was significantly higher than among the 35 patients at first presentation (26 deaths). On discharge from the intensive care unit all survivors had responded well to chemotherapy and had normal or raised peripheral white cell counts. They included seven patients who had recovered from leucopenia (white cell count <0.5 × 10⁹/1). In contrast, 36 of the 47 patients who died were leucopenic at the time of death.The overall mortality of critically ill patients with haematological malignancy is higher than equivalently ill patients without cancer. The dysfunction of an increasing number of organ systems, an APACHE II score of greater than 30, failure of the malignancy to respond to chemotherapy, and persistent leucopenia all point to a poor outcome.     

Venous blood lactate evaluation in equine neonatal intensive care

The use of blood lactate concentration as an indicator of prognosis and disease severity has become a common practice in equine medicine, especially with the validation of handheld analyzers. However, few authors described lactate concentration in critically ill foals, and there are no published studies about the use of handheld analyzers in neonatal foals. In this study, for the first time in the equine neonate, we validated the Lactate Scout analyzer, both in healthy and in critically ill foals. The study also describes the normal range for blood lactate in 26 healthy neonatal foals during the first 72 h of life. Moreover, the utility of venous lactate measurement in 88 critically ill foals was determined, describing lactate values in the most common neonatal pathologies, evaluating serial blood lactate measurements, and investigating its prognostic value. The comparison with the enzymatic-colorimetric reference method showed that the Lactate Scout analyzer is reliable. The mean difference (bias ±2SD) between the two methods was close to zero for all comparisons, and the SD of difference was ±0.76 with a 95% confidence interval from −1.58 to 1.40 mmol/L. In healthy foals, blood lactate concentrations at birth and at 12 h of life were statistically higher (P < 0.01) than lactate concentrations measured at subsequent times. In critically ill foals, the highest lactate concentration at admission was found in hemorrhagic shock, septic shock, and complicated perinatal asphyxia syndrome (PAS). Our results showed that hyperlactatemia, although it does not provide diagnostic information, indicates the severity of illness and the need for an early and aggressive intervention. This could be very useful both during hospitalization and in the field to support veterinarians in making a decision about referral. Furthermore lactatemia proved to be a reliable prognostic parameter: In nonsurviving foals, hyperlactatemia persisted during the entire hospitalization, whereas in survivors there were no significant differences after 24 h from admission. Because prognostic parameters have certain limitations, hyperlactatemia should not be used alone to decide whether to discontinue treatments in critically ill foals. A careful and complete clinical examination is always essential.     

降钙素原联合SOFA评分对老年脓毒症患者预后的评估价值

目的:探讨降钙素原(procalcitonin,PCT)联合SOFA评分(sequential organ failure assessment,SOFA)对老年脓毒症患者预后的评估价值。方法:选择首都医科大学宣武医院急诊抢救室收治的105例老年脓毒症患者,入院后给予血常规、血清PCT水平、血气分析及生化全项等检查,并进行急性生理及慢性健康状况评分(acute physiology and chronic health evaluation,APACHEⅡ)和SOFA评分。根据预后将患者分成死亡组27例和存活组78例,比较两组组患者血清PCT水平、白细胞(WBC)、SOFA评分和APACHEⅡ评分,同时比较和分析APACHEⅡ评分、血清PCT水平、SOFA评分、PCT和SOFA评分联合预测患者死亡的受试者工作特征曲线(Receiver operating characteristic curve,ROC)下面积。结果:死亡组患者血清PCT水平、SOFA评分和APACHEⅡ评分均明显高于存活组(P0.05),两组WBC比较无统计学差异(P=0.132);PCT预测患者死亡的ROC曲线下面积为0.694(P=0.001),SOFA预测患者死亡的ROC曲线下面积为0.660(P=0.012),APACHE II评分预测患者死亡的ROC曲线下面积为0.852(P=0.001),大于PCT和SOFA评分(P0.05),PCT和SOFA评分联合预测患者死亡的ROC曲线下面积0.761(P=0.001),与APACHE II评分比较无统计学差异(P=0.139)。结论:血清PCT水平联合SOFA评分预测老年脓毒症患者预后的临床价值与APACHE II评分相当,均明显优于血清PCT水平和SOFA评分单项检测。     

Lactate Clearance and Vasopressor Seem to Be Predictors for Mortality in Severe Sepsis Patients with Lactic Acidosis Supplementing Sodium Bicarbonate: A Retrospective Analysis

Introduction

Initial lactate level, lactate clearance, C-reactive protein, and procalcitonin in critically ill patients with sepsis are associated with hospital mortality. However, no study has yet discovered which factor is most important for mortality in severe sepsis patients with lactic acidosis. We sought to clarify this issue in patients with lactic acidosis who were supplementing with sodium bicarbonate.

Materials and Methods

Data were collected from a single center between May 2011 and April 2014. One hundred nine patients with severe sepsis and lactic acidosis who were supplementing with sodium bicarbonate were included.

Results

The 7-day mortality rate was 71.6%. The survivors had higher albumin levels and lower SOFA, APACHE II scores, vasopressor use, and follow-up lactate levels at an elapsed time after their initial lactate levels were checked. In particular, a decrement in lactate clearance of at least 10% for the first 6 hours, 24 hours, and 48 hours of treatment was more dominant among survivors than non-survivors. Although the patients who were treated with broad-spectrum antibiotics showed higher illness severity than those who received conventional antibiotics, there was no significant mortality difference. 6-hour, 24-hour, and 48-hour lactate clearance (HR: 4.000, 95% CI: 1.309–12.219, P = 0.015) and vasopressor use (HR: 4.156, 95% CI: 1.461–11.824, P = 0.008) were significantly associated with mortality after adjusting for confounding variables.

Conclusions

Lactate clearance at a discrete time point seems to be a more reliable prognostic index than initial lactate value in severe sepsis patients with lactic acidosis who were supplementing with sodium bicarbonate. Careful consideration of vasopressor use and the initial application of broad-spectrum antibiotics within the first 48 hours may be helpful for improving survival, and further study is warranted.