중증 패혈증 및 패혈성 쇼크 환자에서 예측 인자로서의 시간으로 보정한 젖산 청소율의 유용성
The Usefulness of Lactate Clearance Adjusted to Time as a Predictive Index in Patients with Severe Sepsis and Septic Shock
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Background: The lactate concentration should be used to examine the severity of sepsis or any state of shock. This study was conducted to investigate the prognostic power of the lactate clearance, as adjusted for time, between the survivors and nonsurvivors of patients with severe sepsis or septic shock. Methods: The study was performed on 67 patients over 16 years old and who were admitted to the intensive care unit (ICU) with severe sepsis or septic shock. They were divided into the survivors (n=37) and nonsurvivors (n=30). The blood lactate concentrations were assayed at intervals ranging from 8 to 24 hours and the APACHE III scoring was done daily for 2 weeks or until discharge or death. The lactate clearance, as adjusted for time, was defined using the following formula: [(the maximal lactate concentration-the normal lactate concentration)/the time to normalize the lactate concentration]×1,000. Results: There were no significant differences of age, gender and the length of the ICU stay between the survivors and non-survivors. There were significant difference of the time to measuring the maximal serum lactate concentration (3.2±12.3 hours vs. 28.8±64.6 hours, respectively; p=0.037), the lactate clearance, as adjusted for time (132.27±112.88 mol/L·hour vs. 59.67±72.60 mol/L·hour, respectively; p=0.002), the lactate clearance during 24 hours (46.0±26.3% vs. 22.6±45.6%, respectively; p=0.018) and the APACHE III score (67.6±22.7 vs. 83.9±21.6, respectively; p=0.005) between the survivors and non-survivors. The lactate clearance, as adjusted for time and the APACHE III score were the predictive factors for survival on the logistic regression analysis (odd ratio 0.987; p=0.028 vs. odd ratio 1.046; p=0.006). Conclusions: Lactate clearance, as adjusted for time, could be used as a prognostic index, as well as the APACHE III score, for patients with severe sepsis or septic shock.
Abstract
Background: The lactate concentration should be used to examine the severity of sepsis or any state of shock. This study was conducted to investigate the prognostic power of the lactate clearance, as adjusted for time, between the survivors and nonsurvivors of patients with severe sepsis or septic shock. Methods: The study was performed on 67 patients over 16 years old and who were admitted to the intensive care unit (ICU) with severe sepsis or septic shock. They were divided into the survivors (n=37) and nonsurvivors (n=30). The blood lactate concentrations were assayed at intervals ranging from 8 to 24 hours and the APACHE III scoring was done daily for 2 weeks or until discharge or death. The lactate clearance, as adjusted for time, was defined using the following formula: [(the maximal lactate concentration-the normal lactate concentration)/the time to normalize the lactate concentration]×1,000. Results: There were no significant differences of age, gender and the length of the ICU stay between the survivors and non-survivors. There were significant difference of the time to measuring the maximal serum lactate concentration (3.2±12.3 hours vs. 28.8±64.6 hours, respectively; p=0.037), the lactate clearance, as adjusted for time (132.27±112.88 mol/L·hour vs. 59.67±72.60 mol/L·hour, respectively; p=0.002), the lactate clearance during 24 hours (46.0±26.3% vs. 22.6±45.6%, respectively; p=0.018) and the APACHE III score (67.6±22.7 vs. 83.9±21.6, respectively; p=0.005) between the survivors and non-survivors. The lactate clearance, as adjusted for time and the APACHE III score were the predictive factors for survival on the logistic regression analysis (odd ratio 0.987; p=0.028 vs. odd ratio 1.046; p=0.006). Conclusions: Lactate clearance, as adjusted for time, could be used as a prognostic index, as well as the APACHE III score, for patients with severe sepsis or septic shock.
참고문헌 (20)
- 홍석경, "3차 대학병원 내과계 중환자실 내 중증 패혈증의 유병률과 예후인자", 대한중환자의학회지, 24(1), pp.28~32 (2009), 대한중환자의학회
- Angus DC, "Epidemiology of severe sepsis in the United States: analysis of incidence, outcome, and associated costs of care", Crit Care Med, 29, pp.1303~1310 (2001)
- Brun-Buisson C, "Incidence, risk factors, and outcome of severe sepsis and septic shock in adults. A multicenter prospective study in intensive care units. French ICU group for severe sepsis", JAMA, 274, pp.968~974 (1995)
- Kim HC, "Relationship between change of RBC shape and multi-organ failure in sepsis", Korean J Crit Care Med, 20, pp.63~67 (2005)
- Watts JA, "Bench to bedside: the role of mitochondrial medicine in the pathogenesis and treatment of cellular injury", Acad Emerg Med, 10, pp.985~997 (2003)
- Weil MH, "Experimental and clinical studies on lactate and pyruvate as indicators of the severity of acute circulatory failure (shock)", Circulation, 41, pp.989~1001 (1970)
- Jones AE, "Prospective external validation of the clinical effectiveness of an emergency department-based early goal-directed therapy protocol for severe sepsis and septic shock", Chest, 132, pp.425~432 (2007)
- Moomey CB Jr, "Prognostic value of blood lactate, base deficit, and oxygen-derived variables in an LD50 model of penetrating trauma", Crit Care Med, 27, pp.154~161 (1999)
- Bakker J, "Serial blood lactate levels can predict the development of multiple organ failure following septic shock", Am J Surg, 171, pp.221~226 (1996)
- Nguyen HB, "Early lactate clearance is associated with improved outcome in severe sepsis and septic shock", Crit Care Med, 32, pp.1637~1642 (2004)
- Nast-Kolb D, "Indicators of the posttraumatic inflammatory response correlate with organ failure in patients with multiple injuries", J Trauma, 42, pp.446~454 (1997)
- Lee YJ, "Prognostic implication of serial blood lactate concentrations in SIRS patient", Korean J Crit Care Med, 16, pp.144~150 (2001)
- Levy MM, "2001 SCCM", ESICM, ATS, pp.SIS international sepsis definitions conference, Crit Care Med[DOI]
- Kruse JA, "Significance of blood lactate levels in critically ill patients with liver disease", Am J Med, 83, pp.77~82 (1987)
- Aduen J, "The use and clinical importance of a substrate-specific electrode for rapid determination of blood lactate concentrations", JAMA, 272, pp.1678~1685 (1994)
- Knaus WA, "The APACHE III prognostic system. Risk prediction of hospital mortality for critically ill hospitalized adults", Chest, 100, pp.1619~1636 (1991)
- Manikis P, "Correlation of serial blood lactate levels to organ failure and mortality after trauma", Am J Emerg Med, 13, pp.619~622 (1995)
- Broder G, "Excess lactate: an index of reversibility of shock in human patients", Science, 143, pp.1457~1459 (1964)
- Meregalli A, "Occult hypoperfusion is associated with increased mortality in hemodynamically stable, high-risk, surgical patients", Crit Care, 8, pp.R60~R65 (2004)
- Shapiro NI, "Serum lactate as a predictor of mortality in emergency department patients with infection", Ann Emerg Med, 45, pp.524~528 (2005)