The Role of Hyperlactatemia in Severity of Sepsis
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Date
2020
Authors
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Volume Title
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Rīgas Stradiņa universitāte
Rīga Stradiņš University
Rīga Stradiņš University
Abstract
Pētījuma mērķis: Izvērtēt seruma laktāta līmeni pacientiem ar sepsi intensīvās terapijas nodaļā kā prognostisku biomarķieri, analizējot laktāta līmeni iestājoties nodaļā un tā izmaiņas 24h laikā, kā arī kopā ar pacienta stāvokļa smagumu, pacienta uzturēšanās ilgumu nodaļā un slimības iznākumu.
Ievads: Aprakstīt pētījumu grupu ar aprakstošo statistiku. Izanalizēt saistību starp sākotnējo laktāta līmeni un tā klīrensu laikā (6 un 24 stundas) ar pacienta smaguma pakāpi (SOFA rezultāts), dienu skaitu, kas pavadīts nodaļā un ar pacienta slimības iznākumu (mirstība intensīvās terapijas nodaļā). Izvērtēt laktāta prognostisko vērtību kā biemarķieri un izvērtēt sepses ārstēšanu, izmantojot uz laktātu mērķētu terapiju.
Materiāli un metodes: Šis ir retrospektīvs pētījums, kurā tika apkopoti pacientu dati no 2019.gadā PSKUS intensīvās terapijas nodaļā stacionētiem pacientiem ar diagnozi sepse. Par pacientiem tika ievākti sekojoši dati: dzimums, vecums, pacienta stāvoklis (SOFA punktu skaits), dienu skaits, kas tika pavadīts nodaļā un slimības iznākums (mirstība intensīvās terapijas nodaļā). Tika apkopoti sākotnējā, 6 stundu un 24 stundu laktāta mērījumu rezultāti. Arī 6 un 24 stundu laktāta klīrenss tika aprēķināts. Mainīgie tika sagrupēti un saistības un korelācijas statistikas testi tika pielietoti, izmantojot IBM SPSS Statistics 22.
Rezultāti: Pētījuma grupā ietilpst 31 pacients (n=31). 24 vīrieši (77.4%) un 7 sievietes (22.6%), vecuma mediāna bija 68 gadi, ITN pavadīto dienu mediāna bija 7 dienas un SOFA mediāna bija 10 punkti. Mirstība nodaļā bija 61.3%. Sākotnējā laktāta vērtības mediāna bija 1.9 (IQR = 1.1 – 3.5) mmol/L, laktāta vērtības mediāna pēc 6 stundām bija 1.8 (IQR = 1.5 – 2.5) mmol/L un laktāta vērtības mediāna pēc 24 stundām bija 1.90 (IQR = 1.45 – 2.65) mmol/L. Laktāta klīrenss 6 stundās bija -6.25 % un 24 stundās 0%. Tika konstatēta statistiski ticama ne-lineāra pozitīva un vidēja korelācijas starp sākotnējo laktāta līmeni un SOFA rezultātu (Spīrmana korelācija, rho=0.475, p=0.007). Nozīmīga statistiska saistība tika atrasta starp 24 stundu klīrensu un pacienta SOFA rezultātu (Hī-kvadrāts= 5.855, p=0.016). Starp mainīgajiem un grupām netika atrastas citas statistiski ticams saistības vai korelācijas.
Secinājumi: Sepsi uzskata neatliekamu medicīnisku stāvokli, un seruma laktāta līmenim ir potenciāls būt par nozīmīgu biomarķieri, lai noteiktu pacienta prognozi un tālāko ārstēšanas gaitu. Šajā pētījumā iegūtie dati liecina, ka sākotnējais un vēlāka laika laktāta līmenis dod ātru un vieglu prognostisku informāciju par pacienta stāvokļa smaguma pakāpi. Taču netika atrasta saistība starp laktāta līmeni un dienu skaitu, kas pavadīts intensīvās terapijas nodaļā, un pacienta slimības iznākumu.
Goal of the study: Evaluate value of serum lactate levels as a prognostic biomarker in patients with sepsis in the intensive care unit (ICU) by studying the role of initial lactate and its clearance over time in severity of patient’s condition, length of ICU stay and patient’s outcome. Objectives: Describe epidemiology and basic descriptive statistics of study sample. Study relationship of the initial lactate level and its clearance over time (6 and 24 hours) with severity of patient’s condition (SOFA score), length of ICU stay (days spent on ICU) and patient’s outcome (ICU mortality). Discuss lactate prognostic value as a biomarker and sepsis management using lactate goal-directed therapy. Materials and Methods: Retrospective study of medical reports of patients admitted to the ICU of Pauls Stradiņš Clinical University Hospital during 2019 with the diagnosis of “Sepsis”. Data was collected such as basic epidemiologic data (age and sex), severity of the patient’s condition (SOFA score), length of UCI stay (days in ICU) and patient’s outcome (ICU mortality). Initial lactate, as well as the 6- and 24-hours lactate levels were registered and the 6 and 24h lactate clearance was calculated. Variables were divided in groups and association and correlation studies were conducted using IBM SPSS Statistics 22. Results: Study sample (n=31) consisted of 24 males (77.4%) and 7 females (22.6%), median age of 68 years, median ICU of 7 days and median SOFA score of 10 points. ICU mortality was 61.3%. Median of initial lactate level was 1.9 (IQR = 1.1 – 3.5) mmol/L, of lactate level after 6h was 1.8 (IQR = 1.5 – 2.5) mmol/L, and of lactate level after 24h was 1.90 (IQR = 1.45 – 2.65) mmol/L. Lactate clearance medians for 6 hours was -6.25 % and for 24 hours was 0%. Sample was divided in groups. It was found a statistically significant nonlinear positive and moderate correlation between initial lactate level and SOFA score (Spearman’s correlation, rho=0.475, p=0.007). There was also significant association between groups of 24h lactate clearance and patient’s severity (Chi-square = 5.855, p=0.016). It was not found other significant correlations or associations between variables and groups. Conclusions: Sepsis is considered a medical emergency and lactate has the potential to be a valuable biomarker for prognosis and management of the patient. In this study, initial lactate level and its variation over time appear to provide fast and easy predicting information about severity of patient’s condition in ICU. However, no relationship was found between lactate and length of ICU stay and patient’s outcome (ICU mortality).
Goal of the study: Evaluate value of serum lactate levels as a prognostic biomarker in patients with sepsis in the intensive care unit (ICU) by studying the role of initial lactate and its clearance over time in severity of patient’s condition, length of ICU stay and patient’s outcome. Objectives: Describe epidemiology and basic descriptive statistics of study sample. Study relationship of the initial lactate level and its clearance over time (6 and 24 hours) with severity of patient’s condition (SOFA score), length of ICU stay (days spent on ICU) and patient’s outcome (ICU mortality). Discuss lactate prognostic value as a biomarker and sepsis management using lactate goal-directed therapy. Materials and Methods: Retrospective study of medical reports of patients admitted to the ICU of Pauls Stradiņš Clinical University Hospital during 2019 with the diagnosis of “Sepsis”. Data was collected such as basic epidemiologic data (age and sex), severity of the patient’s condition (SOFA score), length of UCI stay (days in ICU) and patient’s outcome (ICU mortality). Initial lactate, as well as the 6- and 24-hours lactate levels were registered and the 6 and 24h lactate clearance was calculated. Variables were divided in groups and association and correlation studies were conducted using IBM SPSS Statistics 22. Results: Study sample (n=31) consisted of 24 males (77.4%) and 7 females (22.6%), median age of 68 years, median ICU of 7 days and median SOFA score of 10 points. ICU mortality was 61.3%. Median of initial lactate level was 1.9 (IQR = 1.1 – 3.5) mmol/L, of lactate level after 6h was 1.8 (IQR = 1.5 – 2.5) mmol/L, and of lactate level after 24h was 1.90 (IQR = 1.45 – 2.65) mmol/L. Lactate clearance medians for 6 hours was -6.25 % and for 24 hours was 0%. Sample was divided in groups. It was found a statistically significant nonlinear positive and moderate correlation between initial lactate level and SOFA score (Spearman’s correlation, rho=0.475, p=0.007). There was also significant association between groups of 24h lactate clearance and patient’s severity (Chi-square = 5.855, p=0.016). It was not found other significant correlations or associations between variables and groups. Conclusions: Sepsis is considered a medical emergency and lactate has the potential to be a valuable biomarker for prognosis and management of the patient. In this study, initial lactate level and its variation over time appear to provide fast and easy predicting information about severity of patient’s condition in ICU. However, no relationship was found between lactate and length of ICU stay and patient’s outcome (ICU mortality).
Description
Medicīna
Medicine
Veselības aprūpe
Health Care
Medicine
Veselības aprūpe
Health Care
Keywords
Laktāts, sepse, hiperlaktēmija, biomarķieris., Lactate; Sepsis; Hyperlactatemia; Biomarker.