外科ICU围术期血清乳酸水平与术后90天死亡率：回顾性研究
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Peri-operative serum lactate level and postoperative 90-day mortality in a surgical ICU A retrospective association study
背景与目的
关于术前和术后乳酸峰值水平与外科ICU患者死亡率的关系，目前还缺乏足够的研究。本研究旨在探讨外科ICU患者围术期乳酸水平与术后90天死亡率的关系。
方 法
选取2012年1月至2017年12月期间，术后转入同一所三级学院型医院ICU的成年患者进行回顾性队列研究。根据以下血清乳酸水平评估90天死亡率的危险比：术前乳酸水平、术后0~3天乳酸峰值、术后0~3天乳酸水平与术前乳酸水平的δ值。采用多变量Cox回归和受试者工作特征曲线分析数据。
结 果
本研究共纳入9248名患者，其中2511例、8690例和1958例分别测量了术前乳酸水平、术后0~3天乳酸水平和这两个时间点的乳酸水平。术后0~3天的乳酸峰值水平和乳酸δ值均增加1 mmol/ L时，90天死亡率分别增加15%（危险比 1.15；95%CI 1.11～1.19；p<0.001）和14%（危险比 1.14；95%CI 1.11～1.18；P<0.001）；术前乳酸水平与90天死亡率无显著相关性（P=0.069）。经受试者工作特征曲线分析，术后0～3天乳酸峰值曲线下面积（0.72，95%CI 0.70～0.74）大于术前乳酸峰值曲线下面积（0.58，95%CI 0.56～0.60）。
结 论
术后转入ICU的患者中，较高的围手术期乳酸水平与90天死亡率增加有关。术后0~3天的乳酸峰值水平对这种相关性的影响最为显著。
原始文献摘要
Oh TK, Song IA, Jeon YT. Peri-operative serum lactate level and postoperative 90-day mortality in a surgical ICU A retrospective association study.[J].Eur J Anaesthesiol. Jan，2020; 37 (1): 31-37.
BACKGROUND There is inadequate information on the association of pre-operative and postoperative peak level of lactate with mortality of surgical ICU patients.
OBJECTIVE To investigate the association between peri-operative lactate level and 90-day mortality in patients admitted to the surgical ICU.
DESIGN Retrospective cohort study.
SETTING ICUs in single tertiary academic hospital.
PATIENTS Adult patients postoperatively admitted to the ICU between January 2012 and December 2017.
INTERVENTION None.
MAIN OUTCOME MEASURES Hazard ratios of 90-day mortality according to the following serum lactate levels were assessed: pre-operative lactate level; peak lactate levels on postoperative day (POD) 0 to 3; and delta values of the lactate level on POD 0 to 3 from pre-operative lactate level. Multivariable Cox regression and receiver operating characteristic analyses were used.
RESULTS Overall 9248 patients were included, among whom 2511, 8690 and 1958 had measured pre-operative lactate levels, lactate levels within POD 0 to 3, and lactate levels measured at both timepoints, respectively. When the peak lactate level on POD 0 to 3 and delta lactate level all increased by 1 mmol l-1 , 90-day mortality increased by 15% [hazard ratio: 1.15; 95% confidence interval (CI) 1.11 to 1.19; P < 0.001] and 14% (hazard ratio: 1.14; 95% CI 1.11 to 1.18; P < 0.001), respectively; the pre-operative lactate level was not significantly associated with 90-day mortality
(P=0.069). The area under the curve for peak level of lactate on POD 0 to 3 (0.72, 95% CI 0.70 to 0.74) was higher than that of pre-operative lactate level (0.58, 95% CI 0.56 to 0.60) in the receiver operating characteristic analysis.
CONCLUSION In patients admitted postoperatively to the ICU, higher peri-operative lactate levels were associated with increased 90-day mortality. The peak level of lactate during POD 0 to 3 showed the most significant contribution to this association.
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翻译：任文鑫 编辑：冯玉蓉 审校：王贵龙