Effects Of Blood Bicarbonate And Lactic Acid Levels On The Prognosis Of Adult Patients With Sepsis

OBJECTIVE To study and compare the relationship between different levels of lactic acid and the prognosis of sepsis patients,and the effectiveness and ability of blood lactic acid level,SOFA score and qSOFA score in judging the prognosis of sepsis patients.METHODS Participants 92 patients with sepsis were treated in ICU from January 1,2017 to December 31,2018 in the first affiliated Hospital of Nanchang University.A total of 92 cases were collected and divided into two groups: low lactic acid group(n = 46) and high lactic acid group(n = 46).The correlation between lactic acid level and baseline characteristics,clinical signs and laboratory test results were analyzed,univariate and multivariate analysis were performed to determine the predictors of prognosis,and ROC analysis was used to compare lactate with SOFA and qSOFA scores.RESULTS In terms of population baseline information,there was no significant difference in age distribution between the two groups(P > 0.810),and there was no significant difference in sex distribution between the two groups(P > 0.797).In terms of basic vital signs,there was no significant difference in average blood pressure,body temperature and blood oxygen saturation between the two groups(P > 0.001),but there was significant difference in heart rate and respiratory rate between the two groups(P < 0.05).The heart rate and respiratory rate in the low lactic acid group were significantly lower than those in the high lactic acid group.In terms of laboratory examination,there was no significant difference in hemoglobin indexes between the two groups(P < 0.05),but there were significant differences in leukocytes,albumin,bilirubin,blood urea nitrogen,blood sodium bicarbonate and creatinine between the two groups(P < 0.05).Middle bilirubin,blood carbon.There was significant difference in sodium hydrogen acid and creatinine(P < 0.001).There was no significant difference in platelet and sodium ion concentration between the two groups,but there was significant difference in potassium ion concentration and serum lactic acid concentration between the two groups(P < 0.001).In terms of scale score and mortality,there was no significant difference in qSOFA score between the two groups(P < 0.001),but there was significant difference in SOFA score between thetwo groups(P < 0.05).The SOFA score in the high lactic acid group was significantly higher than that in the low lactic acid group.There was no significant difference in the number of deaths between the two groups after 30 days(P < 0.071).According to the analysis of prognostic factors of sepsis,there was significant difference in the average blood pressure of patients after 30 days(P < 0.016).The average blood pressure of patients with survival was lower than that of patients with death.After 30 days,there was a statistical difference in the prognosis of patients with blood sodium bicarbonate(P < 0.017).The concentration of serum sodium bicarbonate in patients with survival was higher than that in patients with death.In terms of age,sex,heart rate,respiratory rate,body temperature and oxygen saturation,hemoglobin concentration,leukocyte count,platelet count,albumin,total bilirubin,blood urea nitrogen creatinine,and serum lactic acid concentration,potassium ion.In terms of concentration and sodium concentration,There was no significant difference in prognosis(P > 0.05).The average blood pressure and blood bicarbonate concentration were suspicious prognostic factors.Mean blood pressure was not an independent factor affecting the prognosis of patients with sepsis(P < 0.072),while blood bicarbonate was an independent factor in patients with sepsis(P < 0.033),indicating that every unit of blood bicarbonate increased within a certain range.The mortality rate fell to 80.7% of the previous level.Blood bicarbonate is an independent protective factor for the prognosis of patients with sepsis.The diagnostic value of lactate,SOFA and qSOFA scores was compared by ROC curve.According to the results of ROC curve analysis,taking qSOFA score as state variable,the diagnostic value of serum lactic acid concentration and SOFA score was less than that of qSOFA score.The area under the curve was 0.423 and 0.424 respectively,but there was no significant difference.CONCLUSION Blood bicarbonate is an independent protective factor for the prognosis of patients with sepsis.It is shown from the side that there is a correlation between the concentration of lactic acid and the increase of hospital mortality.In adult patients with sepsis,the level of lactic acid is simple to use.As a prognostic factor,qSOFA may be superior to SOFA score;qSOFA is more effective in predicting the prognosis of sepsis than lactic acid level and SOFA;lactic acid level can be used as a supplement to qSOFA.