| Background and Objectives:Acute pancreatitis(AP)is a common disease of digestive system,which is an acute inflammatory response of pancreas resulting from various causes.In the early stage of acute pancreatitis,the release of a large number of inflammatory factors causes systemic inflammatory reaction,and tissue fluid flows to the third space,thus leading to the decline of effective circulating blood volume of the body,further leading to insufficient perfusion of each tissue,and causing respiratory dysfunction,renal failure and circulatory dysfunction.Mild acute pancreatitis can heal within a week after treatment,but moderate severe acute pancreatitis and severe acute pancreatitis is often combined with organ dysfunction and infectious pancreatic necrosis,and its mortality can be as high as 20-40%.The current studies show that organ dysfunction is an independent risk factor for death in patients with acute pancreatitis,so recognize the high-risk patients with possible organ dysfunction early,and giving timely and effective treatment can significantly improve acute pancreatitis patients outcomes.Lactic acid is a product of sugar anaerobic glycolysis,when micro-circulation occur disorders,the tissue perfusion is insufficient,the blood lactate value can be significantly increased.It has been shown that arterial blood lactate and lactate clearance were important for predicting the incidence of mortality and persistent organ failure,but its value in acute pancreatitis is unclear.Therefore,we aimed to investigate the effect of lactate and lactate clearance on the prognosis in patients with acute pancreatitis.Methods:We collected 178 patients who were diagnosed with AP in the First Affiliated Hospital of Nanchang University from January 2017 to December 2020.Patients were grouped according to the initial blood lactate level,120 patients were grouped in hyperlactaemia(blood lactate concentration 2-4 mmol/L)and 58 in lactic acidosis(lactate concentration> 4 mmol/L);The effect of blood lactic acid on prognosis of acute pancreatitis was analyzed.Then used 12 h lactate clearance rate of 40% as the cut off value,patients whose lactate clearance<40% were divided into low clearance group,and the lactate clearance≥40% were grouped in high clearance group.Compared the differences in age,sex,days of ICU stay,mortality,APACHE II score,and PMOF incidence between the two groups.Lastly,analyse the correlation between the degree of lactate clearance and the prognosis of AP patients.Results1.Baseline data: A total of 178 patients were enrolled.There had 119 males(66.9%),and the average age total was 49 years.Hyperlipidemic pancreatitis accounted for 43% of the patients,followed by biliary pancreatitis.A total of 145 patients developed persistent organ failure,and 55 patients developed persistent multiple organ dysfunction.The overall mortality was 15.7%,median hospital stay was 19 days,and median ICU stay was 10 days.2.Higher initial lactate levels had higher APACHE II scores on admission and higher incidence of persistent multiple organ failure.3.Compared with the non-PMOF group,the initial lactic acid at 12 h was significantly higher,and the clearance rate of 12 h lactic acid was lower.4.High and low lactate clearance group: Compared with the high clearance group,patients in the low clearance group had a high rate to developed PMOF,persistent respiratory failure,persistent renal failure and ACS,and had a longer time for staying in the ICU(P<0.05).5.Lactate clearance was significantly associated with PMOF,ACS incidence,and ICU admission duration in AP patients(R=-0.169,-0.179,-0.212,P<0.05).conclusion:High lactate level and low lactate clearance indicate the poor prognosis of acute pancreatitis patients.Continuous lactate level measurement and lactate clearance can be used as important indicators for disease evaluation and monitoring of AP patients. |
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