The Study Of Relevance Between The Early Lactate Area And The Prognosis Of Adult Sepsis Patients

Objective: To analysis the clinical significance of early lactate area and its correlation with the severity and prognosis of sepsis patients by dynamic monitoring of arterial blood lactate levels within 24 hours after admission of sepsis patients.Methods: A single-center,prospective study was conducted to select adult sepsis patients who were included in the emergency care unit of the First Affiliated Hospital of Henan University of Science and Technology from September 2015 to December 2016.The basic clinical data of the patients were collected and the vital signs were dynamically monitored.All patients were admitted to the hospital were collected venous blood routine,blood coagulation,liver and kidney function and other laboratory tests in the time of admitted to the hospital.Conducted the arterial blood gas analysis at the time of admission and 6,12,18,24 hours after admission.The lactate clearance rate was calculated according to the calculation formula of lactic acid clearance rate by using the blood lactate concentration data and blood collection time in the recorded blood gas analysis results.Using the recorded arterial blood lactate concentration and time data,calculates the rate of lactate clearance 6 hours depending on the results of blood gas analysis lactate clearance formula.Marked the blood lactate concentration-time data(x=time,y=lactate concentration)on the plane rectangular coordinate system,used straight lines connected the points.Trapezoidal areas were calculated using the formula 0-6h,6-12 h,12-18 h,18-24 h "concentration-time" area under the curve.The results were summed to arrive at the early lactate area within the first 24 hours after admission.The APACHEⅡ and SOFA scores for the first day of hospital admission were calculated based on the recorded residuals and the worst of the test scores.All patients were divided into survival group and non-survival group according to the survival status of follow-up in the 28 th day from admission.The relative clinical data,blood routine,liver and kidney function,initial lactate concentration,6 hour lactate clearance,early lactate area,APACHE Ⅱ score,and SOFA score were compared between the survival group and the non-survival group.The relationship between initial lactate concentration,6 hour lactate clearance rate,early lactate area and APACHEⅡ score,SOFA score was analyzed.Logistic regression analysis was used to analyze the prognostic factors such as initial lactate concentration,early lactate area and APACHEⅡ score.The ROC curve was drawn and the correlation between early lactate area and APACHEⅡ score etc was evaluated by the area under the curve.Results: A total of 120 patients were included,including 66 males and 54 females.Research shows:1.There were statistically significant differences in initiate lactate concentration,early lactate clearance,early lactate area,APACHEⅡ score and SOFA score between the survival group and the non-survival group of sepsis patients(P<0.05).2.The results of Speraman correlation analysis showed that the initial lactic acid concentration was positively correlated with APACHE Ⅱscore and SOFA score(r= 0.659,0.634,P<0.05).The early lactic acid area was positively correlated with APACHE Ⅱscore and SOFA score(r=-0.726,-0.691,P<0.05),and the lactate clearance was negative correlated with APACHE score and SOFA score Ⅱ(r=-0.726,-0.691,P<0.05).3.The results of Logistic regression analysis showed that the initial lactate concentration,the early lactate clearance rate,the early lactate area,the APACHEⅡ score and the SOFA score were the prognostic factors for the prognosis of sepsis patients.The area under the ROC curve of the above indicators is 0.727,0.766,0.936,0.829 and 0.817,respectively.Conclusions:1.The lactate concentration and its dynamic changes were related to the prognosis of patients with sepsis.2.The initial lactate concentration,6 hours lactate clearance rate,the early lactate area,the APACHEⅡ score and the SOFA score could be used as prognostic factors for sepsis survival risk factors,in which the early lactic acid area is optimal.3.Early lactic acid area can be used as a good tool for predicting the prognosis of adult sepsis patients.