Comparison on predictive value of blood lactic acid at different time periods for in-hospital mortality of septic patients: based on the Medical Information Mart for Intensive Care Ⅲ

doi:10.3877/cma.j.issn.1674-6880.2020.01.008

Abstract

Abstract:

Objective

To compare the predictive value of blood lactic acid at different time periods for the in-hospital mortality of septic patients, with a view to providing evidence for rational use of blood lactic acid in clinical practice.

Methods

Based on the Medical Information Mart for Intensive Care Ⅲ, 3 299 patients with sepsis were included. According to their in-hospital survival status, all patients were divided into the in-hospital survival group (n = 2 445) and in-hospital death group (n = 854). The sex ratio, type of intensive care unit, simplified acute physiology score Ⅱ (SAPS Ⅱ), sequential organ failure assessment (SOFA) score, maximum [blood lactic acid (24 h, max)] and minimum [blood lactic acid (24 h, min)] of blood lactic acid within 24 hours of admission, and maximum [blood lactic acid (48 h, max)] and minimum [blood lactic acid (48 h, min)] of blood lactic acid within 24-48 hours were compared between these two groups. Logistic regression analysis and receiver operating characteristic (ROC) curves were used to analyze relevant factors affecting in-hospital mortality in patients with sepsis, and the area under the curve (AUC) was compared using the Z-test.

Results

The blood lactic acid (24 h, max) [3.0 (1.8, 4.8) mmol/L vs. 3.6 (2.1, 6.3) mmol/L], blood lactic acid (24 h, min) [1.5 (1.1, 2.2) mmol/L vs. 1.8 (1.3, 2.9) mmol/L], blood lactic acid (48 h, max) [1.5 (1.1, 2.3) mmol/L vs. 2.5 (1.5, 4.4) mmol/L], blood lactic acid (48 h, min) [1.3 (1.0, 1.8) mmol/L vs. 1.9 (1.3, 3.2) mmol/L], SAPS Ⅱ score [44 (35, 54) vs. 48 (37, 59)] and SOFA score [6 (4, 9) vs. 8 (5, 11)] in the in-hospital survival group were significantly lower than those in the in-hospital death group (H = 7.350, 9.535, 13.473, 12.720, 6.734, 8.033; all P < 0.001). The above indices were included in the Logistic regression analysis which showed that the blood lactic acid (24 h, max) [odds ratio (OR) = 1.099, 95% confidence interval (CI) (1.069, 1.130)], blood lactic acid (24 h, min) [OR = 1.300, 95%CI (1.220, 1.385)], blood lactic acid (48 h, max) [OR = 1.330, 95%CI (1.271, 1.391)], blood lactic acid (48 h, min) [OR = 1.558, 95%CI (1.451, 1.673)], SAPS Ⅱ score [OR = 1.014, 95%CI (1.008, 1.020)] and SOFA score [OR = 1.084, 95%CI (1.059, 1.110)] were risk factors to the in-hospital mortality in septic patients (all P < 0.001). ROC curve analysis showed that blood lactic acid (24 h, max) [AUC = 0.574, 95%CI (0.551, 0.597)], blood lactic acid (24 h, min) [AUC = 0.614, 95%CI (0.591, 0.636)], blood lactic acid (48 h, max) [AUC = 0.693, 95%CI (0.672, 0.715)], blood lactic acid (48 h, min) [AUC = 0.689, 95%CI (0.668, 0.710)], SAPS Ⅱ score [AUC = 0.577, 95%CI (0.555, 0.600)] and SOFA score [AUC = 0.592, 95%CI (0.569, 0.614)] had predictive value for the in-hospital mortality of septic patients (all P < 0.001). The AUCs of blood lactic acid (48 h, max) and blood lactic acid (48 h, min) were significantly higher than those of blood lactic acid (24 h, max) (Z = 7.310, 7.064; both P < 0.001), blood lactic acid (24 h, min) (Z = 5.078, 4.821; both P < 0.001), SAPS Ⅱ score (Z = 7.126, 6.880; both P < 0.001) and SOFA score (Z = 6.204, 5.959; both P < 0.001).

Conclusion

The blood lactic acid of 24-48 h after admission may have better predictive value for the in-hospital mortality of patients with sepsis.

Key words: Blood lactic acid, Sepsis, In-hospital mortality, Prognosis, Medical Information Mart for Intensive Care Ⅲ

Sunbang Yi, Yufeng Hu, Suhan Lin, Yuxi Chen, Jingye Pan. Comparison on predictive value of blood lactic acid at different time periods for in-hospital mortality of septic patients: based on the Medical Information Mart for Intensive Care Ⅲ[J]. Chinese Journal of Critical Care Medicine(Electronic Edition), 2020, 13(01): 39-43.

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References 22

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组别	例数	性别比（例，男/女）	监护室类型[例（%）]
组别	例数	性别比（例，男/女）	心内ICU	胸外ICU	内科综合ICU	普通外科ICU	创伤外科ICU
院内存活组	2 445	1 322/1 123	286（11.7）	270（11.0）	1 119（45.8）	398（16.3）	372（15.2）
院内死亡组	854	486/368	82（9.6）	92（10.8）	395（46.3）	147（17.2）	138（16.2）
χ²/H值	?	2.060	?	?	3.299	?	?
P值	?	0.151	?	?	0.509	?	?
组别	例数	血乳酸（24 h，max，mmol/L）	血乳酸（24 h，min，mmol/L）	血乳酸（48 h，max，mmol/L）	血乳酸（48 h，min，mmol/L）	SAPSⅡ评分（分）	SOFA评分（分）
院内存活组	2 445	3.0（1.8，4.8）	1.5（1.1，2.2）	1.5（1.1，2.3）	1.3（1.0，1.8）	44（35，54）	6（4，9）
院内死亡组	854	3.6（2.1，6.3）	1.8（1.3，2.9）	2.5（1.5，4.4）	1.9（1.3，3.2）	48（37，59）	8（5，11）
χ²/H值	?	7.350	9.535	13.473	12.720	6.734	8.033
P值	?	<0.001	<0.001	<0.001	<0.001	<0.001	<0.001

组别	例数	性别比（例，男/女）	监护室类型[例（%）]
组别	例数	性别比（例，男/女）	心内ICU	胸外ICU	内科综合ICU	普通外科ICU	创伤外科ICU
院内存活组	2 445	1 322/1 123	286（11.7）	270（11.0）	1 119（45.8）	398（16.3）	372（15.2）
院内死亡组	854	486/368	82（9.6）	92（10.8）	395（46.3）	147（17.2）	138（16.2）
χ²/H值	?	2.060	?	?	3.299	?	?
P值	?	0.151	?	?	0.509	?	?
组别	例数	血乳酸（24 h，max，mmol/L）	血乳酸（24 h，min，mmol/L）	血乳酸（48 h，max，mmol/L）	血乳酸（48 h，min，mmol/L）	SAPSⅡ评分（分）	SOFA评分（分）
院内存活组	2 445	3.0（1.8，4.8）	1.5（1.1，2.2）	1.5（1.1，2.3）	1.3（1.0，1.8）	44（35，54）	6（4，9）
院内死亡组	854	3.6（2.1，6.3）	1.8（1.3，2.9）	2.5（1.5，4.4）	1.9（1.3，3.2）	48（37，59）	8（5，11）
χ²/H值	?	7.350	9.535	13.473	12.720	6.734	8.033
P值	?	<0.001	<0.001	<0.001	<0.001	<0.001	<0.001

相关因素	回归系数	标准误	Wald值	P值	OR值	95%CI
血乳酸（24 h，max，mmol/L）	0.112	0.013	70.091	<0.001	1.099	1.069 ~ 1.130
血乳酸（24 h，min，mmol/L）	0.293	0.031	90.395	<0.001	1.300	1.220 ~ 1.385
血乳酸（48 h，max，mmol/L）	0.301	0.022	186.295	<0.001	1.330	1.271 ~ 1.391
血乳酸（48 h，min，mmol/L）	0.466	0.035	179.311	<0.001	1.558	1.451 ~ 1.673
SAPSⅡ评分（分）	0.016	0.003	35.916	<0.001	1.014	1.008 ~ 1.020
SOFA评分（分）	0.093	0.011	67.169	<0.001	1.084	1.059 ~ 1.110

相关因素	回归系数	标准误	Wald值	P值	OR值	95%CI
血乳酸（24 h，max，mmol/L）	0.112	0.013	70.091	<0.001	1.099	1.069 ~ 1.130
血乳酸（24 h，min，mmol/L）	0.293	0.031	90.395	<0.001	1.300	1.220 ~ 1.385
血乳酸（48 h，max，mmol/L）	0.301	0.022	186.295	<0.001	1.330	1.271 ~ 1.391
血乳酸（48 h，min，mmol/L）	0.466	0.035	179.311	<0.001	1.558	1.451 ~ 1.673
SAPSⅡ评分（分）	0.016	0.003	35.916	<0.001	1.014	1.008 ~ 1.020
SOFA评分（分）	0.093	0.011	67.169	<0.001	1.084	1.059 ~ 1.110

相关因素	AUC	95%CI	标准误	敏感度	特异度	P值	约登指数	最佳截点
血乳酸（24 h，max，mmol/L）	0.574	0.551 ~ 0.597	0.012	0.388	0.743	<0.001	0.131	4.751
血乳酸（24 h，min，mmol/L）	0.614	0.591 ~ 0.636	0.011	0.622	0.530	<0.001	0.152	1.551
血乳酸（48 h，max，mmol/L）	0.693	0.672 ~ 0.715	0.011	0.651	0.635	<0.001	0.286	1.852
血乳酸（48 h，min，mmol/L）	0.689	0.668 ~ 0.710	0.011	0.591	0.695	<0.001	0.305	1.644
SAPSⅡ评分（分）	0.577	0.555 ~ 0.600	0.012	0.461	0.669	<0.001	0.130	50.500
SOFA评分（分）	0.592	0.569 ~ 0.614	0.012	0.429	0.712	<0.001	0.141	8.500

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