Lactate Kinetics And Clinical Outcomes In Patients With Septic Shock At High Altitude

Objective:To investigate the effect of lactic acid kinetics on clinical outcomes in patients with septic shock admitted to ICU at high altitude.Method:Patients with septic shock admitted to the ICU of Qinghai University Affiliated Hospital from January 2018 to December 2019 were selected and their APACHE II score,SOFA score,lactic acid level,lactic acid clearance rate and clinical outcome were statistically analyzed.Multivariate Cox analyses risk factors for 28-day clinical outcomes in patients with septic shock and calculates risk ratios（HR）;Kaplan Meier was used to analyze the survival status of the high lactate clearance group and the low lactate clearance rate group;ROC curve calculation and analysis of AUC,to explore the value of SOFA score and APACHEⅡscore in predicting the clinical outcome of patients at 28 days.Results:The Lac₂ level,SOFA score,APACHE II score,hospital mortality,and mortality within 28 days of the high lactate clearance group were significantly lower than those of the low clearance group,and the difference was statistically significant（P<0.05）.Compared with the survival group,the death group had lowerΔ24Lac and higher Lac₂ level,SOFA score,APACHE II score,and the difference was statistically significant（P<0.05）.Multivariate analysis showed APACHEⅡscore,SOFA score,Δ24Lac grouping are independent risk factor for 28-day death.ROC curve analysis showed that SOFA score and APACHEⅡscorehad predictive value for 28 days of clinical outcome in patients with septic shock.Conclusion:At high altitude the low survival rate of patients with septic shock is closely related to the lowΔ24Lac rate.Single lactic acid level cannot accurately predict the clinical prognosis of patients with septic shock,which should be combined with indicators such asΔ24Lac,SOFA score and APACHEⅡ score.