STABİL KOAH OLGULARINDA PLAZMA LAKTAT DÜZEYİ

Year 2021, Volume: 28 Issue: 3, 427 - 432, 13.09.2021

Aylin Pıhtılı Konul Mammadova Esen Kıyan

https://doi.org/10.17343/sdutfd.822908

Abstract

Amaç
Morbidite ve mortalitesi yüksek olan KOAH’da, prognostik
belirteçlerin saptanması önemlidir. Plazma laktat
düzeyi, doku oksijen ihtiyacını gösteren ve kolay
ulaşılabilen bir tetkiktir. Çalışmamızın amacı; stabil
KOAH olgularında plazma laktat düzeyi ile GOLD
KOAH kategorisi, FEV1, ataklar ve hipoksemi arasındaki
ilişkiyi incelemektir.
Gereç ve Yöntem
Göğüs Hastalıkları Polikliniği’ne başvuran stabil dönemdeki
KOAH olguları retrospektif olarak değerlendirildi.
Demografik özellikler, arter kan gazı analizleri,
yıllık atak sayıları, GOLD KOAH kategorisine göre;
A,B,C,D sınıfları, spirometrik parametreler, evde uzun
süreli oksijen tedavisi (USOT) ve non-invaziv mekanik
ventilasyon (NİMV) kullanıp kullanmadıkları kaydedildi.
Bulgular
Toplam 103 stabil KOAH olgusu (E/K: 90/13, ortalama
yaş: 66.8±8.0/yıl) çalışmaya dahil edildi. Olguların
FEV1:%45.7±20.2, FVC:%63.5±22.2, Pa-
O2:66.3±15.0mmHg, PaCO2:43.9±8.3mmHg, laktat:
1.5±0.6 mmol/L idi. On iki olgu(%11.7) A, 16 olgu
(%15.5) B, 25 olgu (%24.3) C, 50 olgu (%48.5) D grubunda
idi. Olguların %47.6’sı (n=49) USOT, %37.3’ü
(n=28) NİMV kullanmakta idi. D kategorisindeki olgularda
laktat düzeyi A, B, C sınıflarına göre belirgin
yüksekti (p<0.001). USOT kullananlarda kullanmayanlara
göre; laktat düzeyi ve PaCO2 belirgin yüksekti
(sırasıyla 1.7±0.7 vs. 1.3±0.5, p<0.001, 47.9±9.4 vs.
40.2±4.8, p<0.001). Laktat düzeyi ile FEV1 (%) arasında
negatif korelasyon mevcuttu (r=-0.32, p=0.001).
Laktat düzeyi, yıllık atak sayısı ≥2 olanlar ve KOAH
atak nedeniyle hastane yatışı olanlarda anlamlı olarak
yüksekti (1.6±0.6 vs 1.2±0.5, p=0.002).Ağır şiddetteki
KOAH’ı öngörmede plazma laktat düzeyinin
1.45mmol/L’nin üzerinde olmasının spesifitesi %68,
sensitivitesi %64 olarak saptandı.
Sonuç
Plazma laktat düzeyi, KOAH kategorisi D olan ve
USOT kullanan olgularda yüksek saptanmıştır. Plazma
laktat düzeyinin KOAH’da prognostik öneminin
olup olmadığının saptanması için konuyla ilgili prospektif
çalışmaların yapılmasına ihtiyaç vardır.

Keywords

GOLD, KOAH, laktat düzeyi

Supporting Institution

Destekleyen kurum yoktur

LACTATE LEVEL IN STABLE COPD PATIENTS

Abstract

Objective
Lactate level is an indicator of tissue oxygenation.
It might be valuable for COPD patients to have
a prognostic marker. Thus, we aimed to evaluate
the relationship between lactate level and COPD
classification, FEV1 level, exacerbations, hypoxemia
in stable COPD patients.
Materials and Methods
In this retrospective study, demographics, arterial
blood gas analysis, exacerbation history, GOLD
classification, pulmonary function tests, long-term
oxygen therapy (LTOT) and non-invasive mechanical
ventilation (NIMV) usage in stable COPD patients
were recorded.
Results
Totally 103 patients (M / F: 90/13, mean age: 66.8 ±
8.0years) were included. Mean FEV1:45±20%, FVC:
63±22%, PaO2:66±15mmHg, PaCO2:43±8mmHg,
lactate level: 1.5±0.6mmol/L. The groups of the
patients according to GOLD COPD classification were
as follows;; 11.7%, 15.5%, 24.3%, 48.5% in A,B,C,D,
respectively. Of patients 47.6% were using LTOT and
37.3% were using NIMV. Lactate level of the patients
in category D was significantly higher than the patients
in A, B, C categories (p<0.001). Lactate level and
PaCO2was significantly higher in patients who used
LTOT (1.7±0.7 vs. 1.3±0.5 p<0.001, 47.9±9.4 vs.
40.2±4.8 p<0.001, respectively). There was a negative
correlation between lactate level and FEV1 (r=-0.32,
p=0.001). Lactate level was significantly higher in
patients who had moderate or severe exacerbation
history (≥2 or ≥1 hospitalization) (p=0.002). Lactate
level above 1.45mmol/L showed 68% specificity and
64% sensitivity for predicting severe COPD.
Conclusion
Lactate level is increased in patients with GOLD
category D and LTOT usage. Prospective studies
are required to determine whether lactate level has
prognostic significance in COPD.

Keywords

GOLD, COPD, lactate level

References

• Referans 1: Neumeier A, Keith R. Clinical Guideline Highlights for the Hospitalist: The GOLD and NICE Guidelines for the Management of COPD. J Hosp Med. 2020;15(4):240-41.
• Referans 2: Global Strategy for the Diagnosis, Management and Prevention of COPD, Global Initiative for Chronic Obstructive Lung Disease (GOLD) 2020. Available from: http://www.goldcopd.org/
• Referans 3:Jansen TC, van Bommel J, Bakker J. Blood lactate monitoring in critically ill patients: a systematic health technology assessment. Crit Care Med. 2009; 37(10):2827–39
• Referans 4: Crawford SO, Ambrose MS, Hoogeveen RC, Brancati FL, Ballantyne CM, Young JH. Association of lactate with blood pressure before and after rapid weight loss. Am J Hypertens. 2008; 21(12):1337–42.
• Referans 5: Zagari F, Jordan M, Stettler M, Zagari F, Jordan M, Stettler M, Broly H, Wurm FM. Lactate metabolism shift in CHO cell culture: the role of mitochondrial oxidative activity. N Biotechnol. 2013; 30(2):238–45.
• Referans 6:Shapiro NI, Trzeciak S, Hollander JE, Birkhahn R, Otero R, Osborn TM, et al. A prospective, multicenter derivation of a biomarker panel to assess risk of organ dysfunction, shock, and death in emergency department patients with suspected sepsis. Crit Care Med. 2009; 37(1):96-104
• Referans 7:Vincent JL, Quintairos E Silva A, Couto Jr L, Taccone FS. The value of blood lactate kinetics in critically ill patients: a systematic review. Crit Care 2016; 20(1):257.
• Referans 8: Zhang Z, Xu X. Lactate clearance is a useful biomarker for the prediction of all-cause mortality in critically ill patients: a systematic review and meta-analysis. Crit Care Med 2014; 42(9):2118–25.
• Referans 9: Haas SA, Lange T, Saugel B, Petzoldt M, Fuhrmann V, Metschke M, et al. Severe hyperlactatemia, lactate clearance and mortality in unselected critically ill patients. Intensive Care Med. 2016; 42(2):202–10
• Referans 10: Galić K, Pravdić D, Prskalo Z, Kukulj S, Starčević B, Vukojević M. Prognostic value of lactates in relation to gas analysis and acid-base status in patients with pulmonary embolism. Croat Med J. 2018; 59(4):149-55.
• Referans 11: Nguyen HB, Rivers EP, Knoblich BP, Jacobsen G, Muzzin A, Ressler JA, et al.Early lactate clearance is associated with improved outcome in severe sepsis and septic shock. Crit Care Med. 2004; 32(8):1637-42
• Referans 12: Nichol AD, Egi M, Pettila V, Bellomo R, French C, Hart G, et al. Relative hyperlactatemia and hospital mortality in critically ill patients: a retrospective multi-centre study. Crit Care 2010; 14(1):25.
• Referans 13: Durmuş U, Doğan NÖ, Pekdemir M, Yılmaz S, Yaka E, Karadaş A, et al.The value of lactate clearance in admission decisions of patients with acute exacerbation of COPD. Am J Emerg Med. 2018 ; 36(6):972-76
• Referans 14:Brasil Santos D, de Assis Viegas CA. Correlation of levels of obstruction in COPD with lactate and six-minute walk test. Rev Port Pneumol. 2009; 15(1):11-25.
• Referans 15:Tanaka Y, Hino M, Morikawa T, Takeuchi K, Mizuno K, Kudoh S. Arterial blood lactate is a useful guide to when rehabilitation should be instigated in COPD. Respirology. 2008; 13(4):564-8.
• Referans 16:Skjørten I, Hilde JM, Melsom MN, Hisdal J, Hansteen V, Steine K, et al. Exercise capacity in COPD patients with exercise-induced pulmonary hypertension. Int J Chron Obstruct Pulmon Dis. 2018; 13:3599-610.
• Referans 17:Quanjer PH, Tammeling GJ, Cotes JE, Pedersen OF, Peslin R, Yemault JC. Lung volumes and forced ventilatory flows.Report working party standardization of lung function tests, European community for steel and coal.Official statement of the European respiratory society. Eur Respir J Suppl. 1993; 16:5–40