ABSTRACT
Objective:
To investigate the relationship between the arterial
blood lactic acid level after entering the
intensive care unit (ICU) and the 28-day
mortality of
patients with
septic shock.
Methods:
The clinical data of 303
patients with
septic shock hospitalized in the department of critical
medicine of the Affiliated
Hospital of Jining Medical College from April 2015 to June 2019 were analyzed retrospectively. According to the
blood lactate (Lac) level, the
patients were divided into <4 mmol/L group ( n=203), 4-10 mmol/L group ( n=69) and >10 mmol/L group ( n=31). The baseline characteristics of the
patients were analyzed. Multiple
logistic regression analysis was used to analyze the independent influencing factors of the 28-day
mortality of
patients with
septic shock. The
receiver operating characteristic (ROC) curve was used to analyze the predictive value of the Lac level after entering the ICU for 28-day
mortality, and
Kaplan-Meier survival curve was performed according to the best cut-off value.
Results:
A total of 303
patients with
septic shock were included, with 179 died in 28 days, and the total
mortality was 59.08%. There were 203, 69, 31
patients in Lac<4 mmol/L, 4-10 mmol/L and >10 mmol/L group, respectively. There were significant differences in Acute
Physiology and Chronic
Health Evalution Ⅱ (
APACHE Ⅱ), Sequential Organ Failure Assessment (SOFA),
oxygenation index (PaO 2/FiO 2), abdominal
infection, the proportion of vasoactive
drugs use among the three groups ( P<0.05). Multiple
logistic regression analysis showed that the independent influencing factor of the 28-day
mortality of
septic shock were age, SOFA, use of
mechanical ventilation,
lactic acid (Lac).
ROC curve analysis showed that the area under the
ROC curve (
AUC) for predicting 28-day
mortality of
patients with
septic shock was 0.604 5 (95% CI 0.540 8-0.668 2). When the optimal cut-off value was 3.55 mmol/L, the
sensitivity was 0.508 4, the
specificity was 0.733 9, the positive likelihood ratio was 1.910 3 and the negative likelihood ratio was 0.669 9. According to the best cut-off value of entrance Lac,
patients were divided into high Lac group (≥3.55 mmol/L) and low Lac group (<3.55 mmol/L), and their 28-day
mortality rates were 73.39%(91/124) and 49.16%(88/179).
Kaplan-Meier survival curve showed that the 28-day
cumulative survival rate of the high Lac group was significantly lower than that of the low Lac group ( P<0.001). Multiple
logistic regression analysis showed that after adjusting for confounding factors, the 28 d
mortality increased to 1.22 times for each increase of 1 mmol/L of Lac [
odds ratio ( OR)=1.22, 95%
confidence interval (95% CI) was 1.08-1.37, P=0.001 4]. The 28 d
mortality in high Lac group was 3.53 times higher than that in low Lac group ( OR=3.53, 95% CI was 1.36-7.09, P=0.000 4).
Conclusions:
In
patients with ICU
septic shock, the arterial
blood Lac level after admission was associated with 28-day
mortality.
Patients with
septic shock whose arterial
blood Lac level exceeded 3.55 mmol/L within 1 hour of entering the room had a significantly increased
risk of
death.