PDF(Pubmed)
Abstract：
This work aimed to investigate the adoption value of blood lactic acid (BLA) combined with the National Early Warning Score (NEWS) in the early screening of sepsis patients and assessing their severity. The data and materials utilized in this work were obtained from the electronic medical record system of 537 anonymized sepsis patients who received emergency rescue in the emergency rescue area of Liuzhou People\'s Hospital, Guangxi, from July 1, 2020, to December 26, 2020. Based on the 28-day outcomes of sepsis patients, the medical records were rolled into Group S (407 survival cases) and Group D (130 dead cases). Basic information such as the mode of hospital admission, initial management, use of emergency ventilator within 24 h of admission, NEWS score, arterial oxygen pressure/alveolar oxygen pressure ratio (PaO2/PAO2), alveolar-arterial oxygen difference (A-aDO2), serum creatinine (SCr), blood urea nitrogen (BUN), oxygenation index (OI), Glasgow Coma Scale (GCS), D-dimer, use of vasoactive drugs within 24 h of admission, C-reactive protein (CRP), procalcitonin (PCT), interleukin-6 (IL-6), N-terminal pro-B-type natriuretic peptide (NT-proBNP), quick Sequential Organ Failure Assessment (qSOFA) score, SOFA score, BLA level, NEWS with lactate (NEWS-L) score, SOFA score including lactate level (SOFA-L) score, Intensive Care Unit (ICU) length of stay, total hospital stay, ICU stay/total hospital stay, and septic shock condition were compared between groups. Logistic regression analysis was performed to assess the impact of various predictive factors on prognosis and to plot the receiver operating characteristic (ROC) curve. The results suggested marked differences between Group S and Group D in terms of mean age (t = -5.620; OR = -9.96, 95 % CI: -13.44∼-6.47; P < 0.001). Group S showed drastic differences in terms of mode of hospital admission (χ2 = 9.618, P < 0.01), method of initial management (χ2 = 51.766, P < 0.001), use of emergency ventilator within 24 h of admission (χ2 = 98.564, P < 0.001), incidence of septic shock (χ2 = 77.545, P < 0.001), use of vasoactive drugs within 24 h of admission (χ2 = 102.453, P < 0.001), heart rate (t = -4.063, P < 0.001), respiratory rate (t = -4.758, P < 0.001), oxygenation status (χ2 = 20.547, P < 0.001), NEWS score (t = -6.120, P < 0.001), PaO2/PAO2 ratio (t = 2.625, P < 0.01), A-aDO2 value (Z = -3.581, P < 0.001), OI value (Z = -3.106, P < 0.01), PLT value (Z = -2.305, P < 0.05), SCr value (Z = -3.510, P < 0.001), BUN value (Z = -3.170, P < 0.01), D-dimer (Z = -4.621, P < 0.001), CRP level (Z = -4.057, P < 0.001), PCT value (Z = -2.783, P < 0.01), IL-6 level (Z = -2.904, P < 0.001), length of hospital stay (Z = -4.138, P < 0.001), total hospital stay (Z = -8.488, P < 0.001), CCU/total hospital stay (Z = -9.118, P < 0.001), NEWS score (t = -6.120, P < 0.001), SOFA score (t = -6.961, P < 0.001), SOFA-L score (Z = -4.609, P < 0.001), NEWS-L score (Z = -5.845, P < 0.001), BLA level (Z = -6.557, P < 0.001), and GCS score (Z = 6.909, P < 0.001) when compared to Group D. The use of ventilators, septic shock, PCT, NEWS score, GCS score, SOFA score, SOFA-L score, NEWS-L score, and BLA level were identified as independent risk factors for predicting the prognosis of sepsis patients (P < 0.001). The areas under ROC curve (AUC) of blood lactic acid, PCT, NEWS, NEWS-L, GCS, SOFA, and SOFA-L were 0.695, 0.665, 0.692, 0.698, 0.477, 0.700, and 0.653, respectively. These findings indicate that the combination of BLA with NEWS (NEWS-L) score and SOFA score has certain advantages in assessing the prognosis of sepsis.
摘要：
目的探讨血乳酸(BLA)联合国家早期预警评分(NEWS)在脓毒症患者早期筛查及严重程度评估中的应用价值。本工作所使用的数据和资料来自柳州市人民医院紧急救援区537名匿名脓毒症患者的电子病历系统,广西,从2020年7月1日至2020年12月26日。根据脓毒症患者的28天结果，将病历纳入S组(407例存活病例)和D组(130例死亡病例).住院方式等基本信息，初始管理，入院后24小时内使用紧急呼吸机，新闻得分,动脉氧压/肺泡氧压比（PaO2/PAO2），肺泡-动脉血氧差异(A-aDO2)，血清肌酐（SCr），血尿素氮(BUN),氧合指数（OI），格拉斯哥昏迷量表（GCS），D-二聚体,入院后24小时内使用血管活性药物，C反应蛋白(CRP),降钙素原(PCT),白细胞介素-6（IL-6），N末端B型利钠肽原(NT-proBNP),快速序贯器官衰竭评估(qSOFA)评分，SOFA得分,BLA级别,含乳酸的新闻（NEWS-L）评分，SOFA评分包括乳酸水平（SOFA-L）评分，重症监护病房（ICU）住院时间，总住院时间,ICU住院时间/总住院时间,比较两组感染性休克情况。进行Logistic回归分析以评估各种预测因素对预后的影响并绘制受试者工作特征（ROC）曲线。结果表明，S组和D组的平均年龄差异有统计学意义（t=-5.620；OR=-9.96，95％CI：-13.44~-6.47；P<0.001）。S组在入院方式上差异显著(χ2=9.618,P<0.01),初始管理方法(χ2=51.766，P<0.001)，入院24h内使用急诊呼吸机(χ2=98.564,P<0.001),感染性休克发生率(χ2=77.545,P<0.001),入院24h内使用血管活性药物（χ2=102.453，P<0.001），心率(t=-4.063,P<0.001),呼吸频率（t=-4.758，P<0.001），氧合状态(χ2=20.547,P<0.001),新闻评分（t=-6.120，P<0.001），PaO2/PAO2比值(t=2.625,P<0.01),A-aDO2值（Z=-3.581，P<0.001），OI值(Z=-3.106,P<0.01),PLT值(Z=-2.305,P<0.05),SCr值（Z=-3.510，P<0.001），BUN值(Z=-3.170,P<0.01),D-二聚体(Z=-4.621,P<0.001),CRP水平(Z=-4.057,P<0.001),PCT值(Z=-2.783,P<0.01),IL-6水平（Z=-2.904，P<0.001），住院时间(Z=-4.138,P<0.001),总住院时间(Z=-8.488,P<0.001),CCU/总住院时间(Z=-9.118,P<0.001),新闻评分（t=-6.120，P<0.001），SOFA评分(t=-6.961,P<0.001),SOFA-L评分(Z=-4.609,P<0.001),NEWS-L评分（Z=-5.845，P<0.001），BLA水平（Z=-6.557，P<0.001），与D组相比，GCS评分（Z=6.909，P<0.001）。感染性休克,PCT,新闻得分,GCS评分,SOFA得分,SOFA-L得分,新闻-L得分,BLA水平是预测脓毒症患者预后的独立危险因素(P<0.001)。血乳酸ROC曲线下面积(AUC),PCT,新闻,新闻-L,GCS,SOFA,SOFA-L分别为0.695、0.665、0.692、0.698、0.477、0.700和0.653。这些发现表明，BLA与NEWS（NEWS-L）评分和SOFA评分的组合在评估脓毒症的预后方面具有一定的优势。
