The Role Of Initial Lactate Evaluation Of The Prognosis Of Patients With Septic Shock And Diabetic Lactic Acidosis

Objective: To explore the role of initial arterial blood lactate on the prognosis of patients with septic shock and diabetic lactic acidosis.Methods: A retrospective analysis involve into 174 patients with septic shock and 24 patients with diabetic lactic acidosis.These patients were divided from the second hospital of Hebei medical university from October 2013 to November 2016.The general data including gender,age,body temperature,pulse,breathing,blood pressure,mean arterial pressure(MAP),liver and kidney function,blood PH value,arterial partial pressure of oxygen(PO2),initi al arterial blood lactate level,acute physiology and chronic health evaluation Ⅱ(APACHE Ⅱ)score.The general clinical information of septic shock group and diabetic lactic acidosis group were compared.The patients were divided into survival group and death group according to the outcome.Differences in their gender,age,MAP,PH,PO2,initial arterial blood lactate level,APACHEⅡ scores were compared.Linear regression analysis was used to analyze the influencing factors between survival group and death group.Drawing the receiver-operating characteristics curve to evaluate the prognosis value of these indicators in septic shock group.Results:1 There were no significant differences in gender,and APACHEⅡ scores between septic shock group and diabetic lactic acidosis group(P>0.05).Compared with septic shock group,age,initial lactate and serum creatinine were significantly increased in the diabetic lactic acidosis group,while the PH was decreased(P <0.05).2 There were no significant differences in gender,age,MAP,PO2 between septic shock survival subgroup and death subgroup(P>0.05).Compared with survival subgroup,initial lactate and APACHE Ⅱ score were significantly increased in the death subgroup,PH was significantly decreased.(P <0.01).3 There ware no significant difference in gender,age,pH,initial lactate and serum creatinine between diabetic lactic acidosis survivial subgroup and death subgroup(P>0.05).Compared with survival group,APACHE Ⅱ score was significantly increased in the death group(P<0.05).4 The results of curve estimation analysis: there was a significant positive correlation between initial lactate and APACHE Ⅱ score for patients both in septic shock and diabetic lactic acidosis group(r=0.803,P<0.01;r=0.796,P<0.01).5 The receiver-operating characteristics curve of septic shock group showed that: area under curve(AUC)of initial lactate was 0.797,95% confidence interval(CI)was(0.722~0.873)(P<0.01);area under AUC of APACHE Ⅱ was 0.722,95%CI(0.644 ~ 0.800)(P<0.01).6 According to the area under curve of septic shock group to predict diabetic lactic acidosis group,the mortality of diabetic lactic acidosis group would increase,while in fact there were only 3 cases of death diabetic lactic acidosis group.The the range of lactate concentration was 15 ~ 29mmol/L in death group.Conclusions:1 There was a significant positive correlation between the initial lactate and the APACHE Ⅱscore.Initial lactate and APACHE Ⅱ score were risk factor affecting the prognosis of patients with septic shock and diabetic lactic acidosis.So these indicators were valuable for evaluating the prognosis of septic shock and diabetic lactic acidosis.2 The prognosis role of initial lactate differed depending on the underlying mechanism of the lactate elevation.For patients with septic shock,the higher the ariterial lactate level was and the worse the prognosis was.For patients with diabetic lactic acidosis,the mortality rate would increace the initial lactate reached a higher level than that in septic shock group.