The Role Of Lactate Clearance In Evaluation Of The Prognosis Of Patients With Sepsis

Objective: Retrospective study to assess the role of arterial blood lactate clearance on the prognosis of patients with sepsis.Methods: A single-center retrospective cohort analysis were involved into a total of 129 patients with sepsis?male 68,female 59?.These patients derived from emergency intensive care unit?EICU?in the second hospital of Hebei medical university from April 2013 to December 2015.The general data including gender,age,infection site,28 days mortality,length of ICU stay,the time of vasoactive drugs were recorded.Temperature,pulse,mean arterial pressure?MAP?,breathing,blood routine test,liver and kidney function,electrolyte,arterial blood lactate level,Procalcitonin?PCT?,oxygenation index?PO₂/FiO₂?,Glasgow coma scale,the sequential organ failure assessment?SOFA?score etc.at the time point of admission to ICU immediatly and 24 hours after treatment were tested.The acute physiology and chronic health evaluation ??APACHE ??score and lactate clearance after admission to ICU 24 hours were calculated.Inclusion criteria: patients meet the diagnostic criteria of sepsis established on the International Sepsis conference in 2012.Exclusion criteria:patients with incomplete clinical data or giving up treatment halfway or died within 24 hours after admission;Acute non-infectious diseases?eg.cardiac shock,myocardial infarction and pulmonary embolism,etc.?;Patients with severe chronic diseases?eg.chronic respiratory failure,heart failure and end-stage kidney disease?associated with organ dysfunction etc.The patients were divided into death group?89 cases?and survival group?39 cases?according to the outcome of 28 days after admission.These clinical indicators of the two groups were analyzed by the SPSS17.0 software.Logistic regression analysis was performed on the indicators affecting the prognosis of patients.Drawing the receiver-operating characteristics curve to evaluate the value of these indicators in patients with sepsis.Results:1 There were no significant differents with gender,age,and the infection sites of patients in two groups?P > 0.05?.2 There were no significant differents with length of ICU stay,MAP,blood PCT,blood lactate level,Scr,SOFA score at the time point of admission to ICU immediatly and the MAP 24 hours after treatment between two groups?P>0.05?;Compared with survival group,the time of vasoactive drugs were significantly prolonged,APACHE ? score and blood PCT,Scr,blood lactate level,SOFA score after treatment 24 hours were significantly increased in the non-survival group?P <0.05?;Compared with survival group,the PO₂/FiO₂ at the time point of admission to ICU immediatly and 24 hours after treatment were significantly decreased,lactate clearance were significantly reduced in the non-survival group?P <0.05?.3 The results of logistic regression analysis: the OR of lactate clearance was 2.05,95%confidence interval?CI?was 1.47 to 1.47;the OR of blood lactic acid level was 0.29,95%CI was 0.09 to 0.63;the OR of blood PCT was 0.49,95%CI was 0.31 to 0.31;the OR of APACHE ? was 0.41,95%CI was 0.17 to 0.71;the OR of SOFA was 0.46,95%CI was 0.23 0.23?P < 0.05?.4 The receiver-operating characteristics curve showed that: area under curve?AUC?of lactate clearance was 0.820?95%CI 0.747 0.894?;area under AUC of blood lactic acid level was 0.799?95%CI 0.742 0.891?;area under AUC of APACHE ? was 0.691?95%CI 0.597 0.785?;area under AUC of SOFA was 0.642?95%CI 0.546 0.737?;area under AUC of blood PCT was 0.625?95% CI 0.526 0.724??P < 0.05?.Conclusions:1 Low lactate clearance,low PO₂/FiO₂,high APACHE ? score and increased blood lactate levels,Scr,blood PCT and SOFA score 24 hours after treatment forecasted poor prognosis in patients with sepsis2 APACHE ? score and lactate clearance,blood lactate level,SOFA score,blood PCT 24 hours after treatment were independent risk factors affecting the prognosis of sepsic patients,so these indicators were valuable for evaluating the prognosis of sepsic patients.3 All above,lactate clearance was the highest independent risk factors affecting the prognosis of sepsic patients,besides the sensitivity and speciality degree of lactate clearance for evaluating the prognosis of sepsic patients were higher,so lactate clearance was a good indicator for evaluating the prognosis of patients with sepsis.