การใช้ซีรัมแลคเตทจากหลอดเลือดดำเพื่อเป็นเป้าหมายในการรักษาภาวะติดเชื้อในกระแสเลือด

Naphitchaya Wiriya

Authors

Naphitchaya Wiriya -

Keywords:

Sepsis, Venous Lactate, Lactate Clearance, Mortality Predictors, Hemodynamic Resuscitation

Abstract

This study aimed to 1) study the mortality rate following baseline and 6-hour venous lactate monitoring, 2) compare baseline venous lactate and 6-hour venous lactate clearance between survivors and non-survivors, and 3) identify predictive factors associated with mortality among patients with sepsis after baseline and 6-hour venous lactate evaluation. This prospective cohort study was conducted among patients diagnosed with sepsis or septic shock at the Emergency Department, Phranarai Maharaj Hospital, between May and September 2023. A sample of 64 eligible adult patients (aged ≥18 years) with baseline venous lactate levels > 4mmol/L was enrolled. Data were collected using a validated clinical record tool. Statistical analyses included descriptive statistics, Student's t-test, Chi-square test, Fisher's exact test, and Binary Logistic Regression.

Results: The majority of patients were male (56.25%) and aged 61–70 years (34.38%). Pneumonia was the primary site of infection (39.06%), and Escherichia coli was the most common pathogen (25.00%). The overall overall mortality rate was 18.75% (12/64). Non-survivors had significantly higher baseline venous lactate levels ( vs ) and significantly lower 6-hour lactate clearance ( vs ) compared to survivors. Additionally, non-survivors exhibited significantly lower initial SBP, DBP, and MAP, alongside significantly higher serum creatinine, BUN, and 6–24 hour fluid resuscitation volumes. Multivariate Binary Logistic Regression identified 5 significant independent predictors of mortality (p≤0.05) 1. 6-hour lactate clearance <10% 2. baseline venous lactate >4 mmol/L 3. serum creatinine ≥ 1.15 mg/dl 4. initial SBP <110 mmHg 5. initial MAP ≤65 mmHg The overall predictive model accounted for 38.8% of variance with an overall prediction accuracy of 71.08%.

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