응급센터로 내원한 저혈압 환자의 사망을 예측할 수 있는 인자들에 대한 연구
Prognostic Factors for Mortality in Emergency Department Patients with Hypotension
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Background: This study was performed to analyze the effects of differences between initial and follow up amounts of central venous oxygen saturation (ScvO_2), lactate, anion gap (AG), and corrected anion gap (CAG). Methods: Patients with systolic blood pressure that was lower than 90 mmHg participated in this study. Along with Arterial Blood Gas Analysis (ABGA), the amounts of electrolytes, albumin, and Scvo_2 were initially checked and then re-checked four hours later. The patients were divided into two groups, which were survived and expired, and the differences in initial and final values were compared in both groups. Results: Out of a total of 36 patients, 29 patients survived and 7 patients died. The data showed almost no difference in mean age, mean arterial pressure, heart rate, respiratory rate, and body temperature between two groups. Comparing the initial amount, there was a statistically significant variation in lactate. Comparing the final values, lactate, AG, and CAG varied significantly. However, for both groups, the differences between the initial and final values were not significant. The area under curve (AUC) of follow up lactate and follow up CAG was 0.89 and 0.88. AUC of ED-APACHEII and original ICU APACHEII was 0.74 and 0.96. Conclusions: There was no prognostic effect of ScvO_2, lactate, AG, and CAG in hypotensive patients. The initial and final values of lactate and CAG were good prognostic factors for the expired group.
Abstract
Background: This study was performed to analyze the effects of differences between initial and follow up amounts of central venous oxygen saturation (ScvO_2), lactate, anion gap (AG), and corrected anion gap (CAG). Methods: Patients with systolic blood pressure that was lower than 90 mmHg participated in this study. Along with Arterial Blood Gas Analysis (ABGA), the amounts of electrolytes, albumin, and Scvo_2 were initially checked and then re-checked four hours later. The patients were divided into two groups, which were survived and expired, and the differences in initial and final values were compared in both groups. Results: Out of a total of 36 patients, 29 patients survived and 7 patients died. The data showed almost no difference in mean age, mean arterial pressure, heart rate, respiratory rate, and body temperature between two groups. Comparing the initial amount, there was a statistically significant variation in lactate. Comparing the final values, lactate, AG, and CAG varied significantly. However, for both groups, the differences between the initial and final values were not significant. The area under curve (AUC) of follow up lactate and follow up CAG was 0.89 and 0.88. AUC of ED-APACHEII and original ICU APACHEII was 0.74 and 0.96. Conclusions: There was no prognostic effect of ScvO_2, lactate, AG, and CAG in hypotensive patients. The initial and final values of lactate and CAG were good prognostic factors for the expired group.
참고문헌 (34)
- Stewart PA, "Modern quantitative acid-base chemistry", Can J Physiol Pharmaco, 61, pp.1441~1461 (1983)
- Fencl V, "Stewart's quantitative acid-base chemistry: applications in biology and medicine", Respir Physiol, 91, pp.1~16 (1993)
- Constable PD, "Hyperchloremic acidosis: the classic example of strong ion acidosis", Anesth Analg, 96, pp.919~922 (2003)
- Friedmann PD, "for the Step’n Out Research Group of CJ-DATS: Collaborative behavioral management: integration and intensification of parole and outpatient addiction treatment services in the Step'n Out study", J Exp Criminol, 5, pp.227~243 (2009)
- Astrup P, "The acid-base metabolism", Lancet, 1, pp.1035~1039 (1960), A new approach
- Oh MS, "The anion gap", N Engl J Med, 297, pp.814~817 (1977)
- Rivers E, "Early Goal-Directed Therapy Collaborative Group: Early goal-directed therapy in the treatment of severe sepsis and septic shock", N Engl J Med, 345, pp.1368~1377 (2001)
- Ho KM, "A comparison of admission and worst 24-hour Acute Physiology and Chronic Health Evaluation II scores in predicting hospital mortality: a retrospective cohort study", Crit Care, 10, pp.R4~ (2006)
- Sankoff JD, "Validation of the Mortality in Emergency Department Sepsis (MEDS) score in patients with the systemic inflammatory response syndrome (SIRS)", Crit Care Med, 36, pp.421~426 (2008)
- McAuliffe JJ, "Hypoproteinemic alkalosis", Am J Med, 81, pp.86~90 (1986)
- Buist M, "An analysis of excess mortality not predicted to occur by APACHE III in an Australian level III intensive care unit", Anaesth Intensive Care, 28, pp.171~177 (2000)
- Angus DC, "Scoring system fatigue...and the search for a way forward", Crit Care Med, 28, pp.2145~2146 (2000)
- Konarzewski W, "Continuing to use APACHE II scores ensures consistency", BMJ, 321, pp.383~384 (2000)
- 임성익, "저혈량성 쇼크 환자에서 병원 내 사망률 예측과 초기 소생술의 치료 지표로서쇼크인덱스, 혈청 젖산 농도, 동맥혈-호기말 이산화탄소 분압차의 유용성", 대한응급의학회지, 18(4), pp.287~293 (2007), 대한응급의학회
- Yoon CH, "Correlation of serum lactate level to prognosis in shock patients", J Korean Soc Emerg Med, 7, pp.506~510 (1996)
- Rady MY, "Resuscitation of the critically ill in the ED: responses of blood pressure, heart rate, shock index, central venous oxygen saturation, and lactate", Am J Emerg Med, 14, pp.218~225 (1996)
- Husain FA, "Serum lactate and base deficit as predictors of mortality and morbidity", Am J Surg, 185, pp.485~491 (2003)
- Nguyen HB, "Early lactate clearance is associated with improved outcome in severe sepsis and septic shock", Crit Care Med, 32, pp.1637~1642 (2004)
- Peretz DI, "The significance of lacticacidemia in the shock syndrome", Ann N Y Acad Sci, 119, pp.1133~1141 (1965)
- Broder G, "Excess lactate: an index of reversibility of shock in human patients", Science, 143, pp.1457~1459 (1964)
- Figge J, "Anion gap and hypoalbuminemia", Crit Care Med, 26, pp.1807~1810 (1998)
- Wilson WC, "Clinical approach to acid-base analysis. Importance of the anion gap", Anesthesiol Clin North America, 19, pp.907~912 (2001)
- Hatherill M, "Correction of the anion gap for albumin in order to detect occult tissue anions in shock", Arch Dis Child, 87, pp.526~529 (2002)
- 신태용, "응급센터 중환자에서 측정한 초기 측정되지 않은 음이온(unmeasured anions): 중환자의 이환율을 예측에 도움이 되는가?", 대한응급의학회지, 17(5), pp.454~462 (2006), 대한응급의학회
- Whittier WL, "Primer on clinical acid-base problem solving", Dis Mon, 50, pp.122~162 (2004)
- Gauthier PM, "Metabolic acidosis in the intensive care unit", Crit Care Clin, 18, pp.289~308 (2002)
- Moviat M, "Conventional or physicochemical approach in intensive care unit patients with metabolic acidosis", Crit Care, 7, pp.R41~R45 (2003)
- Chawla LS, "Anion gap, anion gap corrected for albumin, and base deficit fail to accurately diagnose clinically significant hyperlactatemia in critically ill patients", J Intensive Care Med, 23, pp.122~127 (2008)
- Wo CC, "Unreliability of blood pressure and heart rate to evaluate cardiac output in emergency resuscitation and critical illness", Crit Care Med, 21, pp.218~223 (1993)
- Reinhart K, "Comparison of central-venous to mixed-venous oxygen saturation during changes in oxygen supply", demand, 1989, pp.95, 1216~1221
- Tuchschmidt J, "Elevation of cardiac output and oxygen delivery improves outcome in septic shock", Chest, 102, pp.216~220 (1992)
- Boyd O, "A randomized clinical trial of the effect of deliberate perioperative increase of oxygen delivery on mortality in high-risk surgical patients", JAMA, 270, pp.2699~2707 (1993)
- Rocha Filho JA, "Hyperkalemia accompanies hemorrhagic shock and correlates with mortality", Clinics, 64, pp.591~597 (2009)
- 김상철, "응급센터에 내원한 중환자에서 초기 Strong Ion Gap의 예후적 가치", 대한응급의학회지, 16(1), pp.45~50 (2005), 대한응급의학회