| Objective: To explore the predictive value of different indexes related to prognosis in critically ill patients.Methods: All the cases that met the criteria for selection in the intensive medicine department of the Sixth People’s Hospital affiliated to Shanghai Jiao tong University were collected retrospectively from April 2016 to April 2018,and the predictive effects of different lactic acid changes on the hospitalization outcome of critically ill patients with abnormal lactic acid were studied.The aim was to find the indexes related to the prognosis of critically ill patients,and to discuss the predictive value of initial lactic acid level,24-hour lactic acid clearance rate and APACHEII score on prognosis.Results: There were 1465 patients enrolled,among them,the mortality rate(23.7%)of patients with abnormally persistent increased lactic acid level within 24 hours is higher than patients with decreased lactic acid level(2.7%,p<0.001);indicators related to hospitalization outcomes include: 24 hours lactic acid clearance rate OR=0.525,95%CI(0.412,0.669),p<0.001,APACHEII score: OR=1.223 95%CI(1.177,1.271),p<0.001,initial lactic acid level greater than 4mmol/L:OR=4.326 95%CI(2.625,7.129),p<0.001;The area under the operating characteristic curve(ROC-AUC)of24-hour lactic acid clearance rate predicted hospitalized mortality is 0.620(the sensitivity is 49.3% and the specificity is 71.3%,the cutoff value is 36.6%);The AUC of APACHEII score and the initial lactic acid were: 0.838 and 0.734,respectively.With the increase of initial lactic acid level(4mmol/L and 10mmol/L),the AUC of 24-hour lactate clearance rate was 0.734(the sensitivity is 82.0% and the specificity is 62.0%)and 0.742(the sensitivity is 100.0% and the specificity is 58.3%)respectively,and the AUC was 0.900 when the initial lactic acid and 24-hour lactic acid clearance rate combined with APACHEII score.Conclusion: The hospitalization mortality rate was increased of patients with level of lactic acid greater than 4mmol/l,and the mortality rate was the highest when the level of lactic acid was continued to increase within 24 hours.;initial lactic acid,24-hour lactic acid clearance rate and APACHEII score were the influencing factors of prognosis in critically ill patients,and with the increase of initial lactic acid level,The predictive value on prognosis of 24-hour lactic acid clearance rate was increased,but with low sensitivity and specificity and when combined with initial lactic acid and APACHEII score,it was more effective to predict the death of patients in hospital. |
