败血症患者的正常初始乳酸水平:乳酸对预后预测仍然有用吗?
Xin Lu1, Mubing Qin1, Zengrui Song1
11Emergency Department, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China.
World journal of emergency medicine
|February 2, 2026
概括
在败血症患者的连续乳酸测量显示了影响死亡率的独特表型. 从正常到升高的乳酸盐轨迹表明风险更高,而升高到正常则表明更好的预后,有助于患者分层.
科学领域:
- 关键护理医学 关键护理医学
- 败血症的病理生理学
- 生物标记分析 生物标记分析
背景情况:
- 败血症是一种复杂的综合征,患者的结果各不相同.
- 有限的数据存在于败血症表型和结果,当初始乳酸水平正常时.
- 了解乳酸动态对于败血症管理至关重要.
研究的目的:
- 在败血症患者中识别基于乳酸的临床表型.
- 调查这些表型与住院死亡率之间的关联.
- 评估连续乳酸测量的预后价值.
主要方法:
- 使用MIMIC-IV和eICU数据库进行回顾性队列研究.
- 成年败血症患者分为四种乳酸轨迹表型 (正常-正常,正常-升高,升高-正常,升高-升高) 基于在ICU入院后48小时内进行的连续测量.
- 主要结局是住院死亡率.
主要成果:
- 在四种表型中招募了6926名败血症患者:N-N (24.4%),N-E (3.8%),E-N (36.4%),E-E (35.3%).
- 正常至升高 (N-E) 现型显示,住院死亡风险显著增加 (调整为OR 1.61).
- 提升至正常 (E-N) 类型与最有利的结局相关 (调整的OR为0.41),而提升-提升 (E-E) 具有最高的死亡风险 (调整的OR为3.00).
结论:
- 序列乳酸测量在败血症患者中提供了有价值的预后信息,即使这些患者最初的乳酸水平正常.
- 乳酸轨迹表型可以帮助分层败血症患者进行风险评估和量身定制的管理.
- 需要进一步研究这些乳酸动态背后的机制.
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