The Clinical Value Of Lactic Acid、C-reactive Protein、Red Cell Distribution Width Early Dynamic Monitoring In Critical Illness

Objective: All EICU admissions were monitored blood lactic acid (LAC) levels,serum C-reactive protein (CRP) levels, Red cell distribution width (RDW) levels onadmission to0hour,24hours,48hours,72hours, and evaluated by Acute PhysiologyAnd Chronic Health Evaluation Ⅱ (APACHEⅡ) scoring system. To study thecorrelation between LAC, CRP, RDW levels and APACHEⅡ score respectively, anddiscuss the validity of LAC, CRP, RDW in pathogenetic condition and prognosisassessment of critically-ill patients.Methods: Data were collected prospectively on228EICU admissions fromMarch2011to December2011. The APACHEⅡ score was calculated within the first24hours after admission and monitored LAC, CRP, RDW levels on admission to0hour,24hours,48hours,72hours. Also recording the LAC, CRP, RDW levels in the end(patients leave hospital or die), defining these values as the end point values in thisstudy.228patients were divided into three groups according to their APACHE Ⅱscores:Group I≦15points(50cases); Group II16to30points(84cases); Group III>30points(94cases). And according to28days whether death, divided into the deathgroup(124cases) and the survival group(104cases). Through the statistical methods,analyzing the clinical value of early dynamic changes of LAC, CRP, RDW inpathogenetic condition and prognosis assessment of critically-ill patients.Results:1. The mortality rates of228critically-ill patients in three groups are16%,50%,78.7%respectively, and these increased with increased APACHEⅡ score.2. Using pearson correlation analysis, we have LAC, CRP, RDW-CV levels ofdifferent time points respectively with the APACHEⅡ scoreto do the correlation analysis. We found that: At different time points, LAC levels and APACHE Ⅱ scoresare positively correlated(r=0.602,0.552,0.523,0.494, P all<0.01); At different timepoints, CRP levels and APACHE Ⅱ scores are positivelycorrelated (r=0.198,0.287,0.346,0.384, P all<0.01); At different time points, RDW-CV levels and APACHEⅡscores are not correlated (P all>0.05).3. Q tests were performed with α=0.05, the results as follows:(1) LAC levels areincreased with the rise of APACHEⅡ score among different groups at different timepoints. Groups I are compared with groups II, the differences are not statisticallysignificant (P all>0.05); Groups I are compared with groups III, the differences arestatistically significant (P all<0.05); Groups II are compared with groups III, thedifferences are statistically significant (P all<0.05).(2) Serum CRP levels are increasedwith the rise of APACHE Ⅱ score among different groups at different time points. Atthe admission to0hour, differences of CRP levels among different groups are notstatistically significant (P>0.05); At the admission to24hours,48hours,72hours,groups I are compared with groups III, the differences are statistically significant (Pall<0.05); groups II are compared with groups III, the differences are statisticallysignificant (P all<0.05). At the admission to24hours,72hours, groups I are comparedwith groups II, the differences are not statistically significant (P>0.05); At theadmission to48hours, group I is compared with group II, the difference is statisticallysignificant (P<0.05).(3) RDW-CV levels are not increased with the rise ofAPACHEⅡscore among different groups at different time points. Differences ofRDW-CV levels among different groups are not statistically significant at four timepoints (P all>0.05).4. The tendency charts of LAC, CRP, RDW-CV levels on admission to0hour,24hours,48hours,72hours and in the end of critically-ill patients.(1) The LAC levels onadmission to0hour are the most highest, and then gradually declined, the end to thelowest.(2) The CRP levels after admission gradually raised, the peak on admission to48hours, and then gradually declined, the end to the lowest.(3) The RDW-CV levelsafter admission gradually raised, the peak on admission to72hours, the end to thelowest.5. The comparison of two-sample t-test analysis, we found that: APACHEⅡ scorein the death group is significantly higher than the survival group, the difference isstatistically significant (t=8.872, P<0.01); The LAC levels of different time points, thedeath groups are higher than the survival groups, the differences are statistically significant (t0h=5.770, t24h=4.404, t48h=5.894, t72h=6.397, P all<0.01); The serum CRPlevels of different time points, the death groups are higher than the survival groups, thedifferences are statistically significant (t0h=2.565, t24h=3.841, t48h=5.948, t72h=6.125,P0h<0.05, the rest of the groups P all<0.01); The RDW-CV levels of different timepoints, the death groups are compared with the survival groups, there are no statisticallysignificant differences (t0h=1.096, t24h=0.210, t48h=1.012, t72h=0.875, P all>0.05).6. ICU mortality in Critically-ill patients further on-line multivariate logisticanalysis, the results showed that: among the age, sex, APACHE Ⅱ score and the LAC,CRP, RDW-CV levels on admission to0hour,24hours,48hours,72hours, thevariables that have a significant influence on death are APACHE Ⅱ score, the LAClevels on admission to72hours, the CRP levels on admission to48hours.(PAPACHEⅡ=0.000, PLac=0.002, PCRP=0.002).7. According to mainly disease types in this research,228patients were dividedinto three groups: group A for other system diseases; Group B for blood system diseases;Group C for cardiovascular system diseases. Q tests were performed with α=0.05, theRDW-CV levels of different time points, groups B are compared with groups A, thedifferences are all statistically significant (P all<0.05); groups C are compared withgroups A, the differences are all statistically significant (P all<0.05); groups C arecompared with groups B, the differences are not statistically significant (P all>0.05).Conclusion: Blood LAC, serum CRP level and APACHE Ⅱ score arepositivelycorrelated. They are good indicators of evaluating the severity and prognosis incritically-ill patients. Dynamic monitoring blood LAC, serum CRP levels may be moremeaningful than a single monitoring, helps to find the disease twist. RDW level andAPACHE Ⅱ score have no linear relationship, can not be used to evaluate criticalillness, but this research affirms the significance that apply to the cardiovascular systemdiseases and the blood system diseases. Compared to APACHE Ⅱscore which acquiredata difficultly, blood LAC and serum CRP testing with quick, simple, easy to repeat,cheap characteristics, are the early, sensitive indexes for the severity. For some specialdiseases, blood LAC, serum CRP, RDW and APACHE Ⅱ score with each other, to acertain extent, can improve the prediction effect for critical illness. Blood LAC, serumCRP, RDW may be a new clinical assessment method in critically-ill patients, but atpresent there are still many problems to study, need more forward-looking, rationaldesign, large sample studies to confirm.