Clinical significance of blood lactic acid assisted APACHEⅡ in judging prognosis of elderly SI patients in ICU

doi:10.3969/j.issn.1004-583X.2021.07.005

Abstract

Abstract:

Objective To study the clinical significance of blood lactate acid(LAC) assisted Acute Physiology and Chronic Health Evaluation Ⅱ(APACHE Ⅱ) in judging the prognosis of elderly severe infections (SI) patients in intensive care unit(ICU).Methods The clinical data of 100 elderly SI patients admitted to the ICU ward of our hospital from July 2017 to July 2018 were retrospectively analyzed, and the patients were divided into good prognosis (survival, n=82) and poor prognosis group (death, n=18) according to their prognosis. The general information at admission including gender, age, site of infection, history of alcohol consumption, smoking history, APACHE-Ⅱ score and LAC level were collected in two groups. Multivariate logistic regression analysis was used to predict the risk factors affecting prognosis of elderly SI patients in ICU.Results The age, APACHEⅡ score and LAC level were significantly higher in poor prognosis group than in good prognosis group (P<0.05). ROC analysis confirmed that age, APACHEⅡ score and LAC level could all be used to predict the prognosis of elderly SI patients in ICU. The areas below the curve were 0.878, 0.886 and 0.884, respectively (all P<0.05). Multivariate logistic regression analysis showed that risk factors affecting prognosis of elderly SI patients in ICU were age ≥73 years, APACHEⅡ score ≥13 points, and LAC≥9.145 mmol/L (all P<0.05).Conclusion The prognosis of elderly SI patients in ICU is affected by age, APACHEⅡ score, and LAC. Clinicians should pay close attention to them, which is of great significance to the prognosis evaluation of patients.

Key words: intensive care units, infected, lactic acid, prognosis, aged

CLC Number:

R459.7

Zhang Yuan, Huang Tao, Wang Baoping. Clinical significance of blood lactic acid assisted APACHEⅡ in judging prognosis of elderly SI patients in ICU[J]. Clinical Focus, 2021, 36(7): 604-607.

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URL: https://huicui.hebmu.edu.cn/EN/10.3969/j.issn.1004-583X.2021.07.005

https://huicui.hebmu.edu.cn/EN/Y2021/V36/I7/604

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References 15

[1]	Klouwenberg P, Cremer OL, Vught L, et al. Likelihood of infection in patients with presumed sepsis at the time of intensive care unit admission: A cohort study[J]. Critical Care (London, England), 2015,19(1):319-319. doi: 10.1186/s13054-015-1035-1 URL
[2]	Rodríguez AH, Avilés-Jurado FX, Díaz E, et al. Procalcitonin (PCT) levels for ruling-out bacterial coinfection in ICU patients with influenza: A CHAID decision-tree analysis[J]. J Infect, 2016,72(2):143-151. doi: 10.1016/j.jinf.2015.11.007 URL
[3]	刘旭, 吕隽, 李文强, 等. 急诊脓毒症病死率评分在急诊脓毒症休克患者中的应用研究[J]. 医学临床研究, 2016,33(2):216-220.
[4]	黄洋峰, 蒋薇, 曾杰. C反应蛋白与血清乳酸判断老年患者危重急腹症感染预后的临床意义[J]. 重庆医学, 2015,44(18):2485-2487.
[5]	Katsaragakis S, Papadimitropoulos K, Antonakis P, et al. Comparison of Acute Physiology and Chronic Health Evaluation II (APACHE II) and Simplified Acute Physiology Score II (SAPS II) scoring systems in a single Greek intensive care unit[J]. Crit Care Med, 2000,28(2):426-432. pmid: 10708178
[6]	朱睿瑶, 张迪, 冯丽芝, 等. 血乳酸、胆碱脂酶与APACHE Ⅱ评分在评估危重症患者病情预后中的研究[J]. 医学研究杂志, 2014,43(3):65-67.
[7]	刘伟, 彭丽萍, 华树成. 动态监测重症肺炎患者血乳酸、氧合指数及C反应蛋白的临床意义[J]. 国际呼吸杂志, 2015,35(14):1048-1051.
[8]	邹帅, 张婷, 陈钇然, 等. P(cv-a)CO₂与血乳酸清除率联合监测在感染性休克液体复苏治疗中的应用[J]. 医学临床研究, 2018,35(4):724-726.
[9]	Miguel-Montanes R, Hajage D, Messika J, et al. Use of high-flow nasal cannula oxygen therapy to prevent desaturation during tracheal intubation of intensive care patients with mild-to-moderate hypoxemia[J]. Crit Care Med, 2015,43(3):574-583. doi: 10.1097/CCM.0000000000000743 pmid: 25479117
[10]	柳莹, 刘莉莉, 顾素莲. ICU护士主导的肺复张安全管理机制在老年肺部感染伴低氧血症患者中的应用[J]. 江苏医药, 2016,42(21):2417-2419.
[11]	François B, Mercier E, Gonzalez C, et al. Safety and tolerability of a single administration of AR-301, a human monoclonal antibody, in ICU patients with severe pneumonia caused by Staphylococcus aureus: first-in-human trial[J]. Intensive Care Med, 2018,44(11):1787-1796. doi: 10.1007/s00134-018-5229-2 pmid: 30343314
[12]	Lee B, Na S, Park M, et al. Home return after surgery in patients aged over 85years is associated with preoperative albumin levels, the type of surgery, and APACHE Ⅱ score[J]. World J Surg, 2016,41(4):919-926. doi: 10.1007/s00268-016-3830-5 URL
[13]	刘波, 单南冰. ICU危重患者APACHEⅡ评分变化率和临床预后的关系[J]. 内科急危重症杂志, 2017,23(2):142-144.
[14]	Agrawal N, Gupta T, Agrawal S, et al. Prognosis of critically ill medical intensive care unit patients treated with continuous venovenous hemodialysis[J]. Chest, 2013,144(4):361A-361B. doi: 10.1378/chest.1701604 URL
[15]	韩利红, 马原, 郑有光. 血乳酸在重症感染患者预后中的影响研究[J]. 中华医院感染学杂志, 2015,25(13):2996-2998.

项目	预后不良组 (n=18)	预后良好组 (n=82)	t/χ²值	P值
性别[例(%)]
男女	10(55.56) 8(44.44)	41(50.00) 41(50.00)	0.182	0.669
年龄(岁)	75.23±4.26	72.16±3.21	3.453	0.001
感染部位[例(%)]
肺部	7(38.89)	35(42.68)
腹部	7(38.89)	19(23.17)	2.476	0.480
泌尿道	2(11.11)	19(23.17)
其他	2(11.11)	9(10.78)
吸烟史[例(%)]
有无	10(55.56) 8(44.44)	38(46.34) 44(53.66)	0.502	0.479
饮酒史[例(%)]
有无	12(66.67) 6(33.33)	62(75.61) 20(24.39)	0.614	0.433
APACHEⅡ评分(分)	15.24±6.39	10.24±3.46	4.662	0.000
LAC(mmol/L)	12.48±3.19	7.21±2.19	8.459	0.000

项目	预后不良组 (n=18)	预后良好组 (n=82)	t/χ²值	P值
性别[例(%)]
男女	10(55.56) 8(44.44)	41(50.00) 41(50.00)	0.182	0.669
年龄(岁)	75.23±4.26	72.16±3.21	3.453	0.001
感染部位[例(%)]
肺部	7(38.89)	35(42.68)
腹部	7(38.89)	19(23.17)	2.476	0.480
泌尿道	2(11.11)	19(23.17)
其他	2(11.11)	9(10.78)
吸烟史[例(%)]
有无	10(55.56) 8(44.44)	38(46.34) 44(53.66)	0.502	0.479
饮酒史[例(%)]
有无	12(66.67) 6(33.33)	62(75.61) 20(24.39)	0.614	0.433
APACHEⅡ评分(分)	15.24±6.39	10.24±3.46	4.662	0.000
LAC(mmol/L)	12.48±3.19	7.21±2.19	8.459	0.000

指标	曲线下面积	标准误	P值	95%CI		最佳截断值	敏感度	特异度
指标	曲线下面积	标准误	P值	下限	上限	最佳截断值	敏感度	特异度
年龄	0.878	0.047	0.000	0.786	0.970	73.700	0.778	0.829
APACHEⅡ 评分	0.886	0.050	0.000	0.788	0.984	13.460	0.722	0.988
LAC	0.884	0.063	0.000	0.749	1.000	9.145	0.833	0.988

指标	曲线下面积	标准误	P值	95%CI		最佳截断值	敏感度	特异度
指标	曲线下面积	标准误	P值	下限	上限	最佳截断值	敏感度	特异度
年龄	0.878	0.047	0.000	0.786	0.970	73.700	0.778	0.829
APACHEⅡ 评分	0.886	0.050	0.000	0.788	0.984	13.460	0.722	0.988
LAC	0.884	0.063	0.000	0.749	1.000	9.145	0.833	0.988

因素	回归系数	标准误	Wald χ²值	P值	OR值	95%CI
因素	回归系数	标准误	Wald χ²值	P值	OR值	下限	上限
年龄≥73岁	0.409	0.149	7.571	0.006	1.506	1.125	2.016
APACHEⅡ评分 ≥13分	0.375	0.172	4.764	0.029	1.455	1.039	2.038
LAC≥9.145 mmol/L	1.277	0.432	8.753	0.003	3.587	1.539	8.360