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Abstract：
BACKGROUND: Sepsis is an infection-related systemic inflammatory response that often leads to elevated lactate levels. Monitoring lactate levels during severe sepsis is vital for influencing clinical outcomes. The aim of this study was to assess the association between plasma lactate levels and mortality in children with severe sepsis or septic shock.
METHODS: The current prospective study was conducted in the PICU of University Children\'s Hospital. The International Paediatric Sepsis Consensus Conference criteria for Definitions of Sepsis and Organ Failure in 2005 were used to diagnose patients with sepsis. We measured plasma lactate levels upon admission (Lac H0) and 6 h later (Lac H6). The static indices included the absolute lactate values (Lac H0 and Lac H6), while the dynamic indices included the delta-lactate level (ΔLac) and the 6-hour lactate clearance. The 6-hour lactate clearance was calculated using the following formula: [(Lac H0-Lac H6)100/Lac H0]. ΔLac was calculated as the difference between the Lac H0 and Lac H6 levels. Patient survival or death after a PICU stay was the primary outcome.
RESULTS: A total of 46 patients were included in this study: 25 had septic shock, and 21 had severe sepsis. The mortality rate was 54.3%. The Lac H0 did not significantly differ between survivors and nonsurvivors. In contrast, the survivors had significantly lower Lac H6 levels, higher ΔLac levels, and higher 6-hour lactate clearance rates than nonsurvivors. Lactate clearance rates below 10%, 20%, and 30% were significantly associated with mortality. The best cut-off values for the lactate clearance rate and Lac H6 for the prediction of mortality in the PICU were < 10% and ≥ 4 mmol/L, respectively. Patients with higher Lac H6 levels and lower lactate clearance rates had significantly higher PICU mortality based on Kaplan-Meier survival curve analysis.
CONCLUSIONS: This study highlights the significance of lactate level trends over time for the prediction of mortality in the PICU in patients with severe sepsis or septic shock. Elevated lactate levels and decreased lactate clearance six hours after hospitalisation are associated with a higher mortality rate.
METHODS: The current prospective study was conducted in the PICU of University Children\'s Hospital. The International Paediatric Sepsis Consensus Conference criteria for Definitions of Sepsis and Organ Failure in 2005 were used to diagnose patients with sepsis. We measured plasma lactate levels upon admission (Lac H0) and 6 h later (Lac H6). The static indices included the absolute lactate values (Lac H0 and Lac H6), while the dynamic indices included the delta-lactate level (ΔLac) and the 6-hour lactate clearance. The 6-hour lactate clearance was calculated using the following formula: [(Lac H0-Lac H6)100/Lac H0]. ΔLac was calculated as the difference between the Lac H0 and Lac H6 levels. Patient survival or death after a PICU stay was the primary outcome.
RESULTS: A total of 46 patients were included in this study: 25 had septic shock, and 21 had severe sepsis. The mortality rate was 54.3%. The Lac H0 did not significantly differ between survivors and nonsurvivors. In contrast, the survivors had significantly lower Lac H6 levels, higher ΔLac levels, and higher 6-hour lactate clearance rates than nonsurvivors. Lactate clearance rates below 10%, 20%, and 30% were significantly associated with mortality. The best cut-off values for the lactate clearance rate and Lac H6 for the prediction of mortality in the PICU were < 10% and ≥ 4 mmol/L, respectively. Patients with higher Lac H6 levels and lower lactate clearance rates had significantly higher PICU mortality based on Kaplan-Meier survival curve analysis.
CONCLUSIONS: This study highlights the significance of lactate level trends over time for the prediction of mortality in the PICU in patients with severe sepsis or septic shock. Elevated lactate levels and decreased lactate clearance six hours after hospitalisation are associated with a higher mortality rate.
摘要：
背景：脓毒症是一种与感染相关的全身性炎症反应，通常会导致乳酸水平升高。在严重脓毒症期间监测乳酸水平对于影响临床结局至关重要。这项研究的目的是评估严重脓毒症或脓毒性休克患儿血浆乳酸水平与死亡率之间的关系。
方法：目前的前瞻性研究是在大学儿童医院的PICU进行的。2005年国际儿科脓毒症共识会议关于脓毒症和器官衰竭定义的标准被用于诊断脓毒症患者。我们测量了入院时（LacH0）和6小时后（LacH6）的血浆乳酸水平。静态指标包括绝对乳酸值(LacH0和LacH6)，而动态指标包括δ-乳酸水平（ΔLac）和6小时乳酸清除率。使用以下公式计算6小时乳酸盐清除率:[(LacH0-LacH6)100/LacH0]。ΔLac计算为LacH0和LacH6水平之间的差异。PICU住院后患者存活或死亡是主要结果。
结果：本研究共纳入46例患者：25例感染性休克，21人患有严重脓毒症。死亡率为54.3%。幸存者和非幸存者之间的LacH0没有显着差异。相比之下,幸存者的LacH6水平明显较低，较高的ΔLac水平，6小时乳酸清除率高于非幸存者。乳酸清除率低于10%，20%,30%与死亡率显著相关。预测PICU死亡率的乳酸清除率和LacH6的最佳临界值为<10％和≥4mmol/L，分别。根据Kaplan-Meier生存曲线分析，LacH6水平较高和乳酸清除率较低的患者PICU死亡率明显较高。
结论：本研究强调了乳酸水平随时间变化的趋势对PICU中严重脓毒症或脓毒性休克患者死亡率的预测意义。住院6小时后乳酸水平升高和乳酸清除率降低与较高的死亡率相关。
方法：目前的前瞻性研究是在大学儿童医院的PICU进行的。2005年国际儿科脓毒症共识会议关于脓毒症和器官衰竭定义的标准被用于诊断脓毒症患者。我们测量了入院时（LacH0）和6小时后（LacH6）的血浆乳酸水平。静态指标包括绝对乳酸值(LacH0和LacH6)，而动态指标包括δ-乳酸水平（ΔLac）和6小时乳酸清除率。使用以下公式计算6小时乳酸盐清除率:[(LacH0-LacH6)100/LacH0]。ΔLac计算为LacH0和LacH6水平之间的差异。PICU住院后患者存活或死亡是主要结果。
结果：本研究共纳入46例患者：25例感染性休克，21人患有严重脓毒症。死亡率为54.3%。幸存者和非幸存者之间的LacH0没有显着差异。相比之下,幸存者的LacH6水平明显较低，较高的ΔLac水平，6小时乳酸清除率高于非幸存者。乳酸清除率低于10%，20%,30%与死亡率显著相关。预测PICU死亡率的乳酸清除率和LacH6的最佳临界值为<10％和≥4mmol/L，分别。根据Kaplan-Meier生存曲线分析，LacH6水平较高和乳酸清除率较低的患者PICU死亡率明显较高。
结论：本研究强调了乳酸水平随时间变化的趋势对PICU中严重脓毒症或脓毒性休克患者死亡率的预测意义。住院6小时后乳酸水平升高和乳酸清除率降低与较高的死亡率相关。
