A Retrospective Study On Prognosis Evaluation Of Lactic Acid-related Sepsis Patients Based On MIMIC-Ⅳ Database

Sepsis is a life-threatening organ dysfunction caused by the uncontrolled response of the body to infection.It is a common but difficult to treat syndrome in clinic.Sepsis is an important cause of death in ICU patients with high morbidity and mortality.Hyperlactic acidemia is common in patients with sepsis,especially septic shock,and plays an important role in the occurrence and development of multiple organ dysfunction syndrome(MODS).In this study,sepsis patients were classified according to initial lactic acid value and mean arterial pressure value based on mimic-Ⅳ database,and prognosis and influencing factors were discussed.Objective:This study retrospectively studied the prognosis and influencing factors of patients with lactate-related sepsis by analyzing basic information of patients with sepsis meeting inclusion criteria in MIMIC-IV database.Methods:In this study,first-day ICU admission information of adult patients diagnosed with sepsis or septic shock from mimic-iv database was collected,and the included cases met the diagnostic criteria of Sepsis3.0.First,the patients were grouped according to the initial lactic acid value(LAC)and Mean arterial pressure(MAP)level,and clinical data such as medical records and laboratory indicators were extracted for descriptive statistical analysis.Secondly,the correlation between the prognosis of patients with sepsis was analyzed according to the results of 6-hour retest of lactic acid value,in-hospital mortality,28-day mortality and so on.Finally,COX regression was used to explore the independent risk factors affecting the survival status of patients with sepsis according to the death of patients at 28 days,and to analyze the prognosis evaluation and related influencing factors of patients with clinical sepsis classification of lactic acid and mean arterial pressure.Results:(1)Among the 4085 sepsis patients extracted from mimic-IV database,there were 1663 cases in IA group(LAC<2.0mmol/L and MAP≥65mmHg),422 cases in IB group(LAC<2.0mmol/L and MAP<65mmHg),and 1482 cases in ⅡA group(LAC≥2.0mmol/L and MAP≥65mmHg),and 518 patients in ⅡB group(LAC≥2.0mmol/L and MAP<65mmHg).The mean age of the study population was 63.3±16.9 years,and 60.5%(2470 cases)were male and 60.8%(2482 cases)were white.(2)Retest of lactic acid at 6 hours was positively correlated with mortality in patients with sepsis.The hospitalized survival rate,28-day survival rate,90-day survival rate and 1-year survival rate of patients with high 6-hour lactic acid clearance rate(6-hour lactic acid clearance rate≥40%)were higher than those with low 6-hour lactic acid clearance rate(6-hour lactic acid clearance rate<0%,0%≤6-hour lactic acid clearance rate<20%,20%≤6-hour lactic acid clearance rate<40%),the differences were statistically significant(allp<0.001).(3)The results showed that patients with sepsis complicated with hyperlactacemia had a higher survival rate in hospital when the early fluid resuscitation volume was controlled in the range of 30-45ml/kg.(4)Independent risk factor analysis:Independent risk factor analysis:Univariate risk analysis showed SAPS Ⅱ(95%CI:1.04-1.05,p<0.001),SIRS(95%CI:1.2-1.41,p<0.001),APS Ⅱ(95%CI:1.02-1.03,p<0.001),CC1(95%CI:1.11-1.16,p<0.001)and 6-hour lactate value(95%CI:1.15-1.19,p<0.001).In COX regression models adjusted for different confounding variables,6-hour lactic acid value(HR=1.11,95%CI:1.09-1.13,p<0.001)and SAPS Ⅱ score(HR=1.01,95%CI:1.00-1.02,p<0.001),APS Ⅲ score(HR=1.02,95%CI:1.02-1.02,p<0.001),age(HR=1.01,95%CI:1.01-1.02,p<0.001)and CRRT(HR=2.02,95%CI:1.84-2.63,p<0.001).(5)In the COX regression model adjusted for different confounding variables,the area under ROC curve for 6-hour lactic acid value,SOFA score,SAPS Ⅱ score and APS Ⅲ score were 0.666(95%CI 0.646-0.686),0.612(95%CI 0.592-0.633),0.730(95%CI 0.712-0.748)and 0.771(95%CI 0.754-0.788),respectively.Conclusion:1.Data analysis extracted from the MIMIC-Ⅳ database showed that higher initial lactate values and 6-hour lactate values were associated with death in sepsis patients.2.6-hour lactate clearance≥40%of patients with sepsis had a higher survival rate than 6-hour lactate clearance<40%of patients.Dynamic monitoring of lactate levels and assessment of serum lactate clearance are recommended.3.For sepsis patients with lactate value≥2mmol/L,it is recommended to control the fluid treatment volume of 30-45ml/kg in early(within 3 hours)fluid resuscitation.4.The 6-hour lactate value was an independent risk factor for death in patients with sepsis.Age,6-hour lactic acid value,SOFA score,SAPS Ⅱ score,APS Ⅲ score and other factors have significant significance for the prognostic risk assessment of patients with sepsis.