[Relationship between blood lactic level, lactic clearance, duration of lacticemia and prognosis of critically ill patients in intensive care unit].
OBJECTIVE
To study and quantify the relationship between dynamic lactic acid monitoring indexes and prognosis of critically ill patients in intensive care unit (ICU).


METHODS
One hundred and one critically ill patients with elevated blood lactic acid level were included in this study and divided into death group (n=50) and survival group (n=51). Differences in their lactic acid indexes (including: lactic acid level, duration of lacticemia, lactic clearance), acute physiology and chronic health evaluation II (APACHEII) score, and other clinical indicators which reflected organ/system status were compared, and prognostic significant lacticemia indexes were formulated by multi-variable logistic analysis. Subsequently, patients were grouped by significant lactic indexes separately and compared with incidence of shock/multiple organ dysfunction syndrome (MODS), APACHE II score and mortality.


RESULTS
Differences in lactic acid level, peak lactic acid level, 12-hour and 24-hour lactic acid clearance between death group and survival group showed statistically significant difference (P<0.05 or P<0.01). Peak lactic acid level, 12-hour lactic clearance, APACHE II score and blood pH had significant correlation with prognosis, odds ratios (OR) were 1.466, 0.922, 1.208, 0.032, respectively. Patients with peak lactic acid value> or =10 mmol/L or 12-hour lactic clearance< or =10% had significantly higher mortality: 77.8% and 70.6%, respectively (P<0.05 and P<0.01). Although patients with lacticemia>24 hours had higher mortality, there was no statistically significant difference.


CONCLUSIONS
Peak lactic acid level, 12-hour lactic clearance, APACHE II score and blood pH are good indicators to evaluate patients' prognosis. Peak lactic acid value> or =10 mmol/L or 12-hour lactic clearance< or =10% is an alert of extremely bad prognosis. Prognosis value of duration of lacticemia is limited.
Wang
Hao
H
Intensive Care Unit Department, Qilu Hospital of Shandong University, Jinan 250012, Shandong, China. wanghao34@126.com
Wu
Da-wei
DW
Chen
Xiao-mei
XM
Li
Chen
C
Ding
Shi-fang
SF
Zhai
Qian
Q
Du
Bin-feng
BF
Li
Yuan
Y
Wang
Ke-fu
KF
D018806:APACHE; D000328:Adult; D000368:Aged; D016638:Critical Illness; D005260:Female; D006801:Humans; D007362:Intensive Care Units; D019344:Lactic Acid / Q000097:blood*; D016015:Logistic Models; D008297:Male; D008657:Metabolic Clearance Rate; D008875:Middle Aged; D011379:Prognosis
D019344:Lactic Acid