背景:严重高乳酸血症(乳酸水平≥10mmol/L)与危重患者的高死亡率相关。然而,关于急诊科(ED)患者的数据有限.我们的目的是调查临床特点,ED患者严重高乳酸血症的病因和预后。
方法:在泰国一家三级医院进行了一项回顾性队列研究。我们纳入了在一小时内在ED中采集静脉乳酸样本的成年患者。我们排除了院外心脏骤停后的患者,转移到/从另一家医院或缺少临床数据的医院。在乳酸升高程度增加的患者和严重高乳酸血症患者中评估死亡率,按病因分层。
结果:我们分析了40,047例患者的静脉乳酸水平,分析中包括26,680。其中,1.7%患有严重的高乳酸血症(乳酸≥10mmol/L),10.5%中度(4-9.99mmol/L),28.8%温和(2-3.99mmol/L),和59.0%的正常水平(<2mmol/L)。严重的高乳酸血症与29%的高死亡率相关,37%,在第7天、第28天和第60天分别为38%,重要的ICU入院率和机械通气率。严重高乳酸血症患者被分层为高(>50%死亡率),中等(21-50%),和低(<20%)28天死亡率风险组。高危疾病包括非感染性休克,外伤/烧伤,和神经问题,死亡率为51.1%,61.8%,57.1%,分别。在中等风险组中,即无休克感染患病率高,死亡率为36%。在低风险组中,癫痫发作和昏厥与较低的死亡率相关,死亡率为0%。
结论:在一般ED人群中,与其他程度的乳酸升高相比,严重的高乳酸血症与更高的ICU入院率和死亡率相关。然而,死亡率可能会有很大差异,取决于与不同的主要诊断相关的潜在病因。
BACKGROUND: Severe
hyperlactatemia (lactate level ≥ 10 mmol/L) is associated with high mortality rates in critically ill patients. However, there is limited data on emergency department (ED) patients. We aimed to investigate the clinical characteristics, etiology and outcomes of patients with severe
hyperlactatemia in the ED setting.
METHODS: A retrospective cohort study was conducted at a tertiary care hospital in Thailand. We included adult patients with a venous lactate sample taken in the ED within one hour. We excluded patients after out-of-hospital cardiac arrest, transferred to/from another hospital or those with missing clinical data. Mortality rates were evaluated among patients with increasing degrees of lactate elevation and among patients with severe hyperlactatemia, stratified by causative etiology.
RESULTS: We analyzed venous lactate levels in 40,047 patients, with 26,680 included in the analysis. Among these, 1.7% had severe
hyperlactatemia (lactate ≥ 10 mmol/L), 10.5% moderate (4-9.99 mmol/L), 28.8% mild (2-3.99 mmol/L), and 59.0% normal levels (< 2 mmol/L). Severe
hyperlactatemia was associated with high mortality rates of 29%, 37%, and 38% at 7, 28, and 60 days respectively, significant ICU admissions and mechanical ventilation rates. Patients with severe
hyperlactatemia were stratified into high (> 50% mortality), moderate (21-50%), and low (< 20%) 28-day mortality risk groups. High-risk conditions included non-septic shock, traumatic injuries/burns, and neurological issues, with mortality rates of 51.1%, 61.8%, and 57.1%, respectively. In the moderate risk group, namely infection without shock showed a high prevalence, with a mortality rate of 36%. In the low-risk group, seizures and fainting were associated with lower mortality, exhibiting mortality rates of 0%.
CONCLUSIONS: Severe hyperlactatemia is associated with higher rates of ICU admission and mortality compared to other degrees of lactate elevation in a general ED population. However, mortality rates can vary considerably, depending on the underlying etiology associated with different primary diagnoses.