Yoğun Bakım Ünitesinde Laktat ve Mortalite

Yıl 2022, , 115 - 120, 30.08.2022

Esra Çakır , Işıl Özkoçak Turan

https://doi.org/10.46332/aemj.960131

Öz

Amaç: Çalışmamızda, yoğun bakım ünitesi (YBÜ)’nde sepsis nedeniyle yatan hastalarda yatış laktat düzeyleri ile mortalite ilişkisine bakılması amaçlanmıştır.

Araçlar ve Yöntem: Çalışmamız sepsis nedeniyle Anesteziyoloji ve YBÜ kliniğine yatan hastalarda retrospektif olarak yapıldı. Hastaların demografik ve klinik özellikleri tıbbi dosya kayıtlarından elde edildi. Yatan tüm hastaların serum laktat düzeyleri alındı. Mortalite olan ve olmayan hastalarda demografik özellikler, klinik ve laktat düzeyleri karşılaştırıldı. Mortalite tahmininde eşik laktat değeri ve prediktif tanısal değerini belirlemek için ROC eğrisi istatistiksel analizleri yapıldı.

Bulgular: Çalışma döneminde YBÜ’ye yatan 892 hastadan, 218 tanesi sepsis nedeniyle takip edilip çalışmaya dahil edildi. Laktatın mortaliteyi öngörmedeki ROC eğrisi altında kalan alan 0.862 idi (% 95 GA:0.809–0.905) (p=0.0001). Mortalite için eşik laktat değeri 2.7 mmol/L (duyarlılık: %90.3, %95 GA: 82.4–95.5, özgüllük: %72.8, GA: 64.1–80.4) olarak bulundu.

Sonuç: Laktat, sepsis tanılı hastaların hastane ve YBÜ’lerin mortalitesini göstermede önemli bir belirteçtir. Hastanın yatışından itibaren laktatın yakın takibi tedavi yönetimini ve klinik sonuçları değiştirebilir. 

Anahtar Kelimeler

yoğun bakım ünitesi, mortalite, laktat, sepsis

Destekleyen Kurum

yok

Proje Numarası

yok

Teşekkür

YOK

Lactate and Mortality in the Intensive Care Unit

Öz

Purpose: In our study, we aimed to assess the relationship between the initial value of blood lactate levels and mortality rate in ICU patients with sepsis.

Materials and Methods: Our study was conducted as a retrospective study, and patients admitted to the Anesthesiology Intensive Care Unit with sepsis diagnosis were included. Demographic and clinical characteristics of patients' data were collected and recorded from patients’ medical records. Blood lactate levels were obtained from all patients. Demographic and clinical characteristics and blood lactate levels compared between the mortality occurring and a non-mortality groups of patients. A receiver-operating characteristic (ROC) curve was constructed to assess the best blood lactate level cutoff to predict the mortality rate and diagnostic value of this cutoff level.

Results: During the study period, 892 patients were admitted to ICU and 218 of those with sepsis were included in the study. The area under the ROC curve to predict the mortality rate of blood lactate level was 0.862 (95% CI: 0.809–0.905) (p= 0.0001). The blood lactate cutoff level related to mortality was found to be 2.7 mmol / L (sensitivity: 90.3%, 95% CI: 82.4–95.5, specificity: 72.8%, CI:64.1–80.4).

Conclusion: Lactate levels are important indicator for predicting mortality in patients with sepsis in the hospitals and ICUs. Close follow-up for lactate levels may change the treatment modality and clinical outcome during hospitalization. 

Anahtar Kelimeler

intensive care unit;, mortality, lactate, sepsis

Proje Numarası

yok

Kaynakça

• 1. Armstrong BA, Betzold RD, May AK. Sepsis and Septic Shock Strategies. Surg Clin North Am. 2017;97(6):1339-1379.
• 2. Seymour CW, Liu VX, Iwashyna TJ, et al. Assessment of Clinical Criteria for Sepsis: For the Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3). JAMA. 2016;315(8):762-774.
• 3. Swan KL, Avard BJ, Keene T. The relationship between elevated prehospital point-of-care lactate measurements, intensive care unit admission, and mortality: A retrospective review of adult patients. Aust Crit Care. 2019;32(2):100-105.
• 4. Chebl RB, Tamim H, Dagher GA, Sadat M, Al Enezi F, Arabi YM. Serum Lactate as an Independent Predictor of In-Hospital Mortality in Intensive Care Patients. J Intensive Care Med. 2020;35(11):1257-1264.
• 5. Kompanje EJ, Jansen TC, van der Hoven B, Bakker J. The first demonstration of lactic acid in human blood in shock by Johann Joseph Scherer (1814-1869) in January 1843. Intensive Care Med. 2007;33(11):1967- 1971.
• 6. Ferreruela M, Raurich JM, Ayestarán I, Llompart-Pou JA. Hyperlactatemia in ICU patients: Incidence, causes and associated mortality. J Crit Care. 2017;42(6):200-205.
• 7. Jansen TC, van Bommel J, Schoonderbeek FJ, et al. Early lactate-guided therapy in intensive care unit patients: a multicenter, open-label, randomized controlled trial. Am J Respir Crit Care Med. 2010;182(6):752- 761.
• 8. Cardoso FS, Abraldes JG, Sy E, et al. Lactate and number of organ failures predict intensive care unit mortality in patients with acute-on-chronic liver failure. Liver Int. 2019;39(7):1271-1280.
• 9. Ogura T, Nakamura Y, Takahashi K, Nishida K, Kobashi D, Matsui S. Treatment of patients with sepsis in a closed intensive care unit is associated with improved survival: a nationwide observational study in Japan. J Intensive Care. 2018;6(9):57.
• 10. Dede G, Şahan L, Dede B, Demirbilek S. Kan Laktat seviyesi yoğun bakım hastalarında mortaliteyi tahmin etmede ne kadar etkilidir? Harran Üniv Tıp Fak Derg. 2014;14(1):12-28.
• 11. Yılmaz E, Bor C, Uyar M, Demirağ K, Çankayalı İ. Travma Hastalarının Yoğun Bakıma Kabulündeki Laktat, Albumin, C-reaktif Protein, PaO2/FiO2 ve Glukoz Düzeylerinin Mortaliteye Etkisi. Türk Yoğ Bak Der Derg. 2014;12(3):82-85.
• 12. Hasegawa D, Nishida K, Hara Y, et al. Differential effect of lactate in predicting mortality in septic patients with or without disseminated intravascular coagulation: a multicenter, retrospective, observational study. J Intensive Care. 2019;7(6):35.
• 13. Liu Y, Zheng J, Zhang D, Jing L. Neutrophil-lymphocyte ratio and plasma lactate predict 28-day mortality in patients with sepsis. J Clin Lab Anal. 2019;33(7):e22942.
• 14. Liu Z, Meng Z, Li Y, et al. Prognostic accuracy of the serum lactate level, the SOFA score and the qSOFA score for mortality among adults with Sepsis. Scand J Trauma Resusc Emerg Med. 2019;27(1):51.
• 15. Mahmoodpoor A, Shadvar K, Saghaleini SH, et al. Which one is a better predictor of ICU mortality in septic patients? Comparison between serial serum lactate concentrations and its removal rate. J Crit Care. 2018;44(2):51-56.
• 16. Masevicius FD, Rubatto Birri PN, Risso Vazquez A, et al. Relationship of at Admission Lactate, Unmeasured Anions, and Chloride to the Outcome of Critically III Patients. Crit Care Med. 2017;45(12):e1233-e1239.
• 17. 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):2118-2225.
• 18. Vellinga NAR, Boerma EC, Koopmans M, et al. Mildly elevated lactate levels are associated with microcirculatory flow abnormalities and increased mortality: a microSOAP post hoc analysis. Crit Care. 2017;21(1):255.
• 19. Aduen J, Bernstein WK, Khastgir T, et al. The use and clinical importance of a substrate-specific electrode for rapid determination of blood lactate concentrations. JAMA. 1994;272(21):1678-1685.
• 20. Aksoy Arslan Ö, Arslan Burak, Öztürk G, Tüfek T. Sepsisli Hastalarda Sistatin-C, Pro BNP, Prokalsitonin ve CRP düzeyinin mortalite üzerine etkisi. J Kartal TR. 2015;26(2):122-126.
• 21. Rudd KE, Johnson SC, Agesa KM, et al. Global, regional, and national sepsis incidence and mortality, 1990-2017: analysis for the Global Burden of Disease Study. Lancet. 2020;395(10219):200-211.