摘要
目的评估入急诊时乳酸水平对恶性肿瘤脓毒症/脓毒症休克患者预后的预测价值。方法本研究为回顾性事后分析,数据来自Abou Dagher等[5-6]已发表研究。回顾性收集急诊室最终诊断为脓毒症/脓毒症休克的恶性肿瘤患者176例,排除74例乳酸值缺失的患者,最终纳入102例患者。根据出院时生存状态分为生存组47例,死亡组55例。比较两组入急诊时的乳酸水平并分析患者预后的独立危险因素。结果纳入患者年龄多处于61~80岁,男性患者多于女性。其中73.5%的患者为实质性脏器肿瘤,26.5%为血液系统肿瘤。死亡组患者入急诊时乳酸水平较生存组增高[(5.45±3.74)mmol/L vs(3.06±1.99)mmol/L,P<0.01]。入急诊时乳酸水平预测恶性肿瘤脓毒症/脓毒症休克患者院内病死率的受试者工作特征曲线下面积(area under the receiver operating characteristic curves,AUC)为0.711(95%CI:0.613~0.796,P<0.01)。调整其他混杂因素后,入急诊时乳酸水平(OR=1.326,95%CI:1.026~1.714,P=0.031)和尿素氮水平(OR=1.038,95%CI:1.003~1.074,P=0.037)是预测恶性肿瘤脓毒症/脓毒症休克患者院内病死率的独立危险因素。结论早期乳酸水平可以作为判断恶性肿瘤脓毒症及脓毒性休克患者预后的一个重要指标。
Objective To evaluate the prognostic value of lactate level in cancer patients with sepsis/septic shock.Methods This study was a retrospective analysis with the data from a published study by Abou Daghter et al.One-hundred-and-seventy-six patients with cancer were diagnosed as sepsis/septic shock in the emergency department.After excluding 74 patients with no lactate data,102 patients were eventually included.According to the state of survival at discharge,47 patients were in the survival group and 55 patients in the death group.Lactate levels were compared between the two groups at emergency admission and independent risk factors for patient prognosis were analyzed.Categorical variables were compared usingχ2,adjustedχ2 or Fisher test.Quantitative variables were compared using Student's t test or non-parameter test.Results Most of the included patients were between 61 and 80 years old,and male patients were more than female patients.Among the included patients,73.5%were parenchymal organ tumors and 26.5%were with hematological tumors.The lactate level of the death group were significantly higher than that of the survival group[(5.45±3.74)mmol/L vs(3.06±1.99)mmol/L,P<0.01].The area under the receiver operating characteristic curve(AUC)of lactate level in predicting hospital-mortality was 0.711(95%CI:0.613-0.796,P<0.01).After adjusting for other confounding factors,the lactate level(OR=1.326,95%CI:1.026-1.714,P=0.031)and urea nitrogen level(OR=1.038,95%CI:1.003-1.074,P=0.037)were independently associated with hospital-mortality in cancer patients with sepsis/septic shock.Conclusion The early lactate level is useful in predicting the prognosis of cancer patients with sepsis/septic shock.
作者
冯霞
冷报浪
梁斌
杜康
Feng Xia;Leng Baolang;Liang Bin;Du Kang(Department of Respiratory Medicine,Hangzhou Third Hospital,Hangzhou 310009,China)
出处
《实用肿瘤杂志》
CAS
2019年第6期534-539,共6页
Journal of Practical Oncology
