The Evaluation To The Disease Severity And Prognosis In Sepsis Children By Lactate And Lactate Clearance Rate

Objective：This study aims at comparing the differences of the mean arterial pressure（MAP）, PICS score and prognosis among different levels of lactate, and the variation of early lactate clearance rate，and atevaluating the disease severity and clinical prognostic significance in sepsis children, in order to provide certain theoretical basis for guiding clinical treatment and evaluating prognosis.Methods：1Cases and grouping：fifty-eight children with sepsis admitted intoPediatric Intensive Care Unit of the second hospital of Hebei medical university from March2012to September2013were collected in this study． All children were excluded from the conditions which may raise serum lactate，such as diabetes, tumor, congenital metabolic diseases, liverand kidney disease et.al.The diagnosis of pediatric septic series accordingto diagnostic criteria established by the international pediatric sepsis consensus conference in2005. The study started from when children entered the PICU. initial blood pressure, lactate level and PCIS score were recorded. The first PICS score shall be completed within24hours and itshould be repeatedly measured according to the change of illness, The abnormal data was used as an index of disease severity. The scores weredefined as <70extremely critical,71-80critical, and>80noncritical. Lactate levels in the arterial blood were measured again after6hours andthen the lactate clearance rate was calculated. The children were dividedinto3groups according to initial lactic acid levels: low (<2.0mmol/L),median (2.0-3.9mmol/L), high (≧4.0mmol/L). compare the MAP, PCIS,prognosis respectively．The children also were divided into survival gro up and death group according to the prognosis, and the difference of the6h lactate clearance rates were compared.2Sample collection, processing and data measurement:1.5ml arterialblood were extracted when the children were admitted to the hospital0hour and6hours respectively. Using disposable vacuum syringe of heparin anticoagulant in standard level concentration and the blood samples were processed rapidly with blood lactate analyzer, we got the data ofarterial blood lactate of0h and6h and then calculate the lactate clearance rate of6h:[(0h arterial blood lactate level-6h arterial blood lactate levels)/0h arterial blood lactate level] x100%.3Statistical methods: statistical analysis were used with software SPSS17, the enumeration data adopted X2test, represented by X+s, Intergroup comparison used t-test, the measurement data in multiple groupswere compared with one-way ANOVA, non normal distribution were showed as median (quartile range), inter group comparison adopted nonparametric test, P<0.05was considered statistically significant.Results：1The comparison of the death and survival rate among the levelsof lactate: the number of the low level is29case, the number of themiddle level is19case and the number of the high level is10case, the prognosis has statistical difference among different lactic acid levels(X2=9.309P=0.01), the different comparisons among the three groups showed that: there were significant differences between low lactate level and middle lactate level (X2=5.035P=0.045), the prognosis had statistical difference between the low lactate level and high lactate level group (X2=9.381P=0.007), there were no significant difference between the middle lactate and the high level group (X2=0.944P=0.432).2The PICS scores among different lactic acid levels were statistically significant (X2=23.54P<0.001), the PICS scores were statistically significant between low and middle levels of lactate, and between low and high levels of lactate groups had statistics difference, and between the midd le and high level of lactic acid had significant difference (Z=-2.541P=0.011, Z=-4.393P<0.001, Z=-3.273P=0.00respectively).3The comparison of the mean arterial pressure among different levels of lactic acid had no significant difference (X2=3.885P>0.05). The lactic acid and blood pressure were used as the remarks for evaluating tissue perfusion, but there were no statistical significant., when lactic acid in sepsis early was increased, blood pressure may still was a normal level.4The difference lactate clearance rate between death group and survival between was statistically significant (t=4.675P<0.001), the6hour lactate clearance rate of survival group was significantly higher than the group of death.Conclusions:1The prognosis in middle and high lactate level is higher than low lactate level, and there is no statistical significance between the high level and middle level. This demonstrated that when the lactic acid level is greater than2mmol/l, it is significant for evaluating prognosis. The PCIS score has statistical significance among different lactic acid levels. When the lactic acid level is higher, the PICS score lower,through the comparison between lactic acid and blood pressure, the initial serum lactate is more sensitive than blood pressure in tissue hypoperfusion. Therefore, the initial serum lactate levels in children sepsis could be used as a good indicator of disease severity and prognosis.26h lactate clearance rate is significantly higher in survival group than death group, and the higher lactate clearance shows the children withsepsis can recover the perfusion of visceral organs and tissue oxygen function in short time. Therefore Lactic acid level and early lactate clearancerate can be used as a marker for disease severity and prognosis of patients with severe sepsis．...