血乳酸在判断新生儿败血症预后中的临床价值
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摘要
目的探讨动脉血乳酸水平在判断新生儿败血症预后中的临床价值。方法收集301例败血症新生儿的临床资料,主要包括入院时血乳酸、C反应蛋白、降钙素原等生化指标。通过ROC曲线分析,评估入院时血乳酸水平对判断新生儿败血症预后的价值。结果足月儿血乳酸重度升高组病死率(26.1%)较轻度升高组(3.1%)和乳酸正常组(0%)明显升高(P<0.017)。预后不良组入院时血乳酸水平(6.5±5.1 mmol/L)较预后良好组(3.6±1.7 mmol/L)明显升高(P<0.05)。入院时血乳酸水平(临界值为6.15 mmol/L)对判断新生儿败血症预后的敏感性和特异性分别为0.545、0.919。结论早期血乳酸水平可作为判断新生儿败血症预后的生化指标,特异性高,但敏感性较低。[中国当代儿科杂志,2019,21(7):629-634]
Objective To explore the clinical value of arterial blood lactate level in predicting the prognosis of neonatal sepsis. Methods The clinical data of 301 cases of neonatal sepsis were collected,which mainly included biochemical indicators such as blood lactate on admission,C-reactive protein,and procalcitonin. ROC curves were plotted to evaluate the value of lactate level on admission in predicting the prognosis of neonatal sepsis. Results The mortality rate was significantly higher for full-term infants in the severely-elevated lactate group than in the mildlyelevated lactate group and the normal lactate group(26.1% vs 3.1% and 0%; P<0.017). The poor prognosis group had a significantly increased lactate level on admission compared with the good prognosis group(6.5±5.1 mmol/L vs 3.6±1.7 mmol/L; P<0.05). The sensitivity and specificity of blood lactate level on admission(cutoff value:6.15 mmol/L) were0.545 and 0.919 respectively,in predicting the prognosis of neonatal sepsis. Conclusions Early blood lactate level can be used as a biochemical parameter to predict the prognosis of neonatal sepsis as it has a high specificity but a low sensitivity. [Chin J Contemp Pediatr,2019,21(7):629-634]
Objective To explore the clinical value of arterial blood lactate level in predicting the prognosis of neonatal sepsis. Methods The clinical data of 301 cases of neonatal sepsis were collected,which mainly included biochemical indicators such as blood lactate on admission,C-reactive protein,and procalcitonin. ROC curves were plotted to evaluate the value of lactate level on admission in predicting the prognosis of neonatal sepsis. Results The mortality rate was significantly higher for full-term infants in the severely-elevated lactate group than in the mildlyelevated lactate group and the normal lactate group(26.1% vs 3.1% and 0%; P<0.017). The poor prognosis group had a significantly increased lactate level on admission compared with the good prognosis group(6.5±5.1 mmol/L vs 3.6±1.7 mmol/L; P<0.05). The sensitivity and specificity of blood lactate level on admission(cutoff value:6.15 mmol/L) were0.545 and 0.919 respectively,in predicting the prognosis of neonatal sepsis. Conclusions Early blood lactate level can be used as a biochemical parameter to predict the prognosis of neonatal sepsis as it has a high specificity but a low sensitivity. [Chin J Contemp Pediatr,2019,21(7):629-634]
引文
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[7]中华医学会儿科学分会新生儿学组,中华医学会中华儿科杂志编辑委员会.新生儿败血症诊疗方案[J].中华儿科杂志,2003,41(12):897-899.
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[11]中华医学会儿科学分会新生儿学组,中国医师协会新生儿科医师分会感染专业委员会.新生儿败血症诊断及治疗专家共识(2019年版)[J].中华儿科杂志,2019,57(4):252-257.
[12]Cantey JB,Baird SD.Ending the culture of culture-negative sepsis in the neonatal ICU[J].Pediatrics,2017,140(4).pii:e20170044.
[13]Schuetz P,Birkhahn R,Sherwin R,et al.Serial procalcitonin predicts mortality in severe sepsis patients:results from the multicenter procalcitonin monitoring sepsis(MOSES)study[J].Crit Care Med,2017,45(5):781-789.
[14]冯亚群,胡祥华,梁亚勇.联合检测降钙素原和超敏C反应蛋白对新生儿败血症早期诊断的临床价值[J].实用医学杂志,2010,26(9):1582-1584.
[15]Yang A,Liu J,Yue L,et al.Neutrophil CD64 combined with PCT,CRP and WBC improves the sensitivity for the early diagnosis of neonatal sepsis[J].Clin Chem Lab Med,2016,54(2):345-351.
[16]Perrone S,Lotti F,Longini M,et al.C reactive protein in healthy term newborns during the first 48 hours of life[J].Arch Dis Child Fetal Neonatal Ed,2018,103(2):F163-F166.
[17]龚红蕾,徐美玉,施晓民,等.血清PA、ALB和CRP在小儿脓毒症急性期和恢复期的水平变化[J].江苏医药,2014,40(19):2284-2285.
[18]Arora S,Singh P,Singh PM,et al.Procalcitonin levels in survivors and nonsurvivors of sepsis:systematic review and meta-analysis[J].Shock,2015,43(3):212-221.
[19]Meisner M.Pathobiochemistry and clinical use of procalcitonin[J].Clin Chim Acta,2002,323(1-2):17-29.
[20]Fukuzumi N,Osawa K,Sato I,et al.Age-specific percentilebased reference curve of serum procalcitonin concentrations in Japanese preterm infants[J].Sci Rep,2016,6:23871.
[21]安莹波.早期动脉血乳酸水平和乳酸清除率对评估严重脓毒症患者预后的临床价值[J].微循环学杂志,2013,23(3):50-51.
[22]陈爱斌,茅双根.新生儿感染性休克的诊断及治疗[J].中华全科医学,2018,16(7):1049-1050.
[23]Ha T,Shin T,Jo IJ,et al.Lactate clearance and mortality in septic patients with hepatic dysfunction[J].Am J Emerg Med,2016,34(6):1011-1015.
[24]Casserly B,Phillips G,Schorr C,et al.Lactate measurements in sepsis-induced tissue hypoperfusion:results from the Surviving Sepsis Campaign database[J].Crit Care Med,2015,43(3):567-573.
[25]颜海鹏,卢秀兰,仇君,等.血乳酸在脓毒症患儿病情及预后评价中的意义[J].中国当代儿科杂志,2016,18(6):506-510.
[26]廖继旸,袁金霞,韩云,等.成人乳酸清除率指导脓毒症复苏治疗价值的Meta分析[J].解放军医学杂志,2018,43(9):761-768.
[27]Scott HF,Brou L,Deakyne SJ,et al.Lactate clearance and normalization and prolonged organ dysfunction in pediatric sepsis[J].J Pediatr,2016,170:149-155.e1-4.
[28]Arnold RC,Shapiro NI,Jones AE,et al.Multicenter study of early lactate clearance as a determinant of survival in patients with presumed sepsis[J].Shock,2009,32(1):35-39.
[2]王政力,余加林.新生儿败血症诊断新进展[J].中国当代儿科杂志,2013,15(3):236-241.
[3]Shane AL,Sánchez PJ,Stoll BJ.Neonatal sepsis[J].Lancet,2017,390(10104):1770-1780.
[4]Zea-Vera A,Ochoa TJ.Challenges in the diagnosis and management of neonatal sepsis[J].J Trop Pediatr,2015,61(1):1-13.
[5]Ryoo SM,Lee J,Lee YS,et al.Lactate level versus lactate clearance for predicting mortality in patients with septic shock defined by sepsis-3[J].Crit Care Med,2018,46(6):e489-e495.
[6]Jia Y,Wang Y,Yu X.Relationship between blood lactic acid,blood procalcitonin,C-reactive protein and neonatal sepsis and corresponding prognostic significance in sick children[J].Exp Ther Med,2017,14(3):2189-2193.
[7]中华医学会儿科学分会新生儿学组,中华医学会中华儿科杂志编辑委员会.新生儿败血症诊疗方案[J].中华儿科杂志,2003,41(12):897-899.
[8]Mohammed I,Nonas SA.Mechanisms,detection,and potential management of microcirculatory disturbances in sepsis[J].Crit Care Clin,2010,26(2):393-408.
[9]Russell J,Lee T,Singer J,et al.The Septic Shock 3.0 definition and trials:a vasopressin and septic shock trial experience[J].Crit Care Med,2017,45(6):940-948.
[10]Rojas-Marcial C,Pedraza-Zárate Má,Bautista-Barranco H,et al.Lactate levels with regards to the pulse pressure in patients with shock[J].Rev Med Inst Mex Seguro Soc,2016,54(1):16-19.
[11]中华医学会儿科学分会新生儿学组,中国医师协会新生儿科医师分会感染专业委员会.新生儿败血症诊断及治疗专家共识(2019年版)[J].中华儿科杂志,2019,57(4):252-257.
[12]Cantey JB,Baird SD.Ending the culture of culture-negative sepsis in the neonatal ICU[J].Pediatrics,2017,140(4).pii:e20170044.
[13]Schuetz P,Birkhahn R,Sherwin R,et al.Serial procalcitonin predicts mortality in severe sepsis patients:results from the multicenter procalcitonin monitoring sepsis(MOSES)study[J].Crit Care Med,2017,45(5):781-789.
[14]冯亚群,胡祥华,梁亚勇.联合检测降钙素原和超敏C反应蛋白对新生儿败血症早期诊断的临床价值[J].实用医学杂志,2010,26(9):1582-1584.
[15]Yang A,Liu J,Yue L,et al.Neutrophil CD64 combined with PCT,CRP and WBC improves the sensitivity for the early diagnosis of neonatal sepsis[J].Clin Chem Lab Med,2016,54(2):345-351.
[16]Perrone S,Lotti F,Longini M,et al.C reactive protein in healthy term newborns during the first 48 hours of life[J].Arch Dis Child Fetal Neonatal Ed,2018,103(2):F163-F166.
[17]龚红蕾,徐美玉,施晓民,等.血清PA、ALB和CRP在小儿脓毒症急性期和恢复期的水平变化[J].江苏医药,2014,40(19):2284-2285.
[18]Arora S,Singh P,Singh PM,et al.Procalcitonin levels in survivors and nonsurvivors of sepsis:systematic review and meta-analysis[J].Shock,2015,43(3):212-221.
[19]Meisner M.Pathobiochemistry and clinical use of procalcitonin[J].Clin Chim Acta,2002,323(1-2):17-29.
[20]Fukuzumi N,Osawa K,Sato I,et al.Age-specific percentilebased reference curve of serum procalcitonin concentrations in Japanese preterm infants[J].Sci Rep,2016,6:23871.
[21]安莹波.早期动脉血乳酸水平和乳酸清除率对评估严重脓毒症患者预后的临床价值[J].微循环学杂志,2013,23(3):50-51.
[22]陈爱斌,茅双根.新生儿感染性休克的诊断及治疗[J].中华全科医学,2018,16(7):1049-1050.
[23]Ha T,Shin T,Jo IJ,et al.Lactate clearance and mortality in septic patients with hepatic dysfunction[J].Am J Emerg Med,2016,34(6):1011-1015.
[24]Casserly B,Phillips G,Schorr C,et al.Lactate measurements in sepsis-induced tissue hypoperfusion:results from the Surviving Sepsis Campaign database[J].Crit Care Med,2015,43(3):567-573.
[25]颜海鹏,卢秀兰,仇君,等.血乳酸在脓毒症患儿病情及预后评价中的意义[J].中国当代儿科杂志,2016,18(6):506-510.
[26]廖继旸,袁金霞,韩云,等.成人乳酸清除率指导脓毒症复苏治疗价值的Meta分析[J].解放军医学杂志,2018,43(9):761-768.
[27]Scott HF,Brou L,Deakyne SJ,et al.Lactate clearance and normalization and prolonged organ dysfunction in pediatric sepsis[J].J Pediatr,2016,170:149-155.e1-4.
[28]Arnold RC,Shapiro NI,Jones AE,et al.Multicenter study of early lactate clearance as a determinant of survival in patients with presumed sepsis[J].Shock,2009,32(1):35-39.