ABSTRACT
Objective:To investigate the clinical value of continuous increase of blood lactic acid (Lac) in prognosis evaluation of patients with sepsis.Methods:From January 2016 to December 2018, 84 patients with sepsis in the Department of Critical Medicine of Lanzhou First People's Hospital were retrospectively analyzed. According to the final outcome, the patients were divided into death group and survival group. The general condition, initial Lac, Lac at 6, 12, 18, 24 h, and the duration of Lac>2 mmol/L (T Lac>2) were compared between the two groups. Receiver operating characteristic curve (ROC) was used to analyze the sensitivity and specificity of gender, age, acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ), initial lac, 6, 12, 18, 24 h lac, T Lac>2 in evaluating the prognosis of patients with sepsis. At the same time, the relationship between these parameters and the prognosis of patients was analyzed by Cox regression analysis to evaluate the clinical value of the time of continuous increase of blood lactate in the prognosis of patients with sepsis. Results:There was no significant difference in age, gender, APACHE Ⅱ score and initial lac between the two groups ( P>0.05). The Lac of death group was higher than that of survival group at 6, 12, 18 and 24 h after treatment ( P<0.05), and T Lac>2 in death group was significantly longer than that in survival group ( P<0.05). Cox regression analysis showed that age, gender, APACHE Ⅱ score, initial Lac, 6, 12, 18, 24 h lac had no significant effect on the prognosis of sepsis patients, while T Lac>2 was significantly correlated with survival rate and death risk. The longer T Lac>2 was, the lower the survival rate and the higher the risk of death. At the same time, ROC curve analysis showed that gender, age, APACHE Ⅱ score and area under the curve (AUC) of initial lac showed that these indicators could not effectively evaluate the prognosis of patients ( P>0.05). The area under the curve of T Lac>2 was the largest, and the evaluation of prognosis was the best, followed by 24 h Lac and 18 h, 12 h and 6 h Lac. In addition, the sensitivity of T Lac>2, 24, 18, 12, 6 h for sepsis mortality risk assessment were 90.9%, 81.8%, 81.8%, 81.8%, 88.6%, and the specificity were 71.4%, 52.5%, 52.5%, 47.7% and 25.2%, respectively. Conclusions:Transient increase of lactic acid can not evaluate the prognosis of patients with sepsis, but the duration of lactic acid increase has a significant impact on the prognosis of patients with sepsis. The longer the increase of Lactic acid (T Lac>2) is, the lower the survival rate and the higher the risk of death. The sensitivity and specificity of lactic acid duration in evaluating the risk of death were higher than those of other parameters, and the prognostic efficacy was the best.