初始血乳酸水平和序贯器官功能衰竭评分对腹腔感染患者预后的评估

目的 危重症患者高乳酸水平是疾病严重程度的一个重要指标，探讨腹腔感染患者血乳酸水平的变化和序贯器官功能衰竭(SOFA)评分的关系，为腹腔感染患者严重程度及预后判断提供参考。 方法 选取温州医科大学附属第一医院2015年2月—2017年10月收治的63例腹腔感染患者，记录患者的一般资料、APACHE Ⅱ评分和SOFA评分，记录初始血乳酸水平，按血乳酸水平分为高乳酸组(Lac>2 mmol/L)49例和正常组(Lac≤2 mmol/L)14例。比较高乳酸血症组和正常组的临床资料。运用ROC曲线下面积(area under the curve,AUC)来计算初始乳酸和APACHE Ⅱ、SOFA评分的最佳截点；各指标间的相关性进行Pearson相关性检验；运用logistic回归分析筛选影响预后的危险因素。 结果 高乳酸血症组的APACHE Ⅱ评分和SOFA评分较正常组均明显升高[15.00(12.00，20.25)分 vs. 10.00(10.00，12.75)分、7.00(6.00，9.00)分 vs. 5.00(3.00，6.00)分，均P<0.05]。乳酸、APACHE Ⅱ评分和SOFA评分三者的AUC分别为(0.692、0.787、0.726，P=0.022、0.002、0.041)，预测病死率的最佳截点分别是5.0 mmol/L、13.5分和6.5分。Pearson相关性分析示血乳酸与APACHE Ⅱ、SOFA评分均呈正相关(r=0.594,P<0.001；r=0.562,P<0.001)，logistic回归分析示乳酸和APACHE Ⅱ评分是影响腹腔感染患者预后的独立危险因素(P=0.003、0.015)。 结论 腹腔感染患者入院时的初始乳酸水平是评估预后的一个独立危险因素，与APACHE Ⅱ、SOFA评分呈正相关，若联合APACHE Ⅱ和SOFA评分，则评估预后效果更好。 

Prognostic value of initial blood lactate level and SOFA score in patients with intra-abdominal infection

Objective The high blood lactic acid level in critically ill patients is an important indicator of the severity of the disease. The purpose of this study was to explore the relationship between the blood lactic acid level and SOFA score, and provide a reference for the assessment of the severity of the illness and prognosis of patients with intra-abdominal infection. Methods Total 63 patients with intra-abdominal infection admitted to the first affiliated hospital of Wen-Zhou Medical University in February 2015 to October 2017 were enrolled into this study. The general information, acute physiology and chronic health evaluation (APACHE) Ⅱ score, SOFA score were recorded. The initial blood lactate level was recorded, the clinical data were compared between the hyperlactatemia group (Lac > 2 mmol/L) and the normal group (Lac≤2 mmol/L). By using the area under the ROC curve to calculate the cut-off point of the initial lactic acid， APACHE Ⅱ, and Sequential Organ Failure Assessment (SOFA) score. Pearson analysis was conducted to analyze the correlation between lactic acid, APACHE Ⅱ score and SOFA score. logistic regression analysis was performed to analyze the risk factors affecting the prognosis. Results Among the 63 patients, the incidence of hyperlactic acidemia rate was 77.8%. The APACHE Ⅱ score and SOFA score in the hyper-lactic acid group were significantly higher than that in the normal group [15.00(12.00, 20.25) vs. 10.00(10.00, 12.75), 7.00(6.00,9.00) vs. 5.00(3.00,6.00), all P<0.05)]. The AUC among lactic acid, APACHE Ⅱ score and SOFA score were 0.692, 0.787, 0.726 respectively (P=0.022, 0.002, 0.041). The optimal cut-off point of them were 5.0 mmol/L, 13.5 and 6.5, respectively. Pearson correlation analysis showed that blood lactate was positively correlated with APACHE Ⅱ and SOFA scores (r=0.594, P<0.001; r=0.562, P<0.001). Logistic regression analysis showed that the level of lactic acid and APACHE Ⅱ score were independent risk factors for the prognosis of patients with intra-abdominal infection disease (P=0.003,0.015). Conclusion High blood lactic acid on admission in patients with intra-abdominal infection is an independent risk factor for assessing prognosis. Besides, it is an important quantitative indicator in assessing the severity of the disease, if combined with the APACHE Ⅱ and SOFA score.