Prediction of mortality in sepsis patients using simplified acute physiology score Ⅱ score combined with lactate clearance rates at different moments_Chinese Journal of Respiratory and Critical Care Medicine

Authors：

JIANG Xuejiao ^1,2 ,  ZHANG Fengxiang ²

1. Graduate School of Jinzhou Medical University, Jinzhou, Liaoning 121000, P. R.China;
2. Department of Critical Care Medicine, First Affiliated Hospital of Jinzhou Medical University Jinzhou, Liaoning 121000, P. R.China;

Corresponding?author：

ZHANG Fengxiang, Email: zhangfengxiang64@163.com

Keywords：

Simplified acute physiological score Ⅱ; lactate clearance rate; sepsis; death

DOI：

10.7507/1671-6205.202306032

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Objective To explore the predictive value of simplified acute physiological score Ⅱ (SAPS-Ⅱ) combined with lactate clearance rates (LCR) at different moments for mortality in sepsis patients. Methods A total of 188 patients with sepsis admitted in the hospital from April 2020 to February 2023 were selected, who were evaluated using the SAPS-Ⅱ scale. Spectrophotometry was used to detect blood lactate at baseline, after 6h, 12h, 24h, and 48h, then the LCR after 6h, 12h, 24h, and 48h were calculated. The patients were divided into a survival group (n=139) and a death group (n=37) based on 28 day outcome. Logistic regression analysis was used to explore the risk factors of sepsis death, and the efficacy of SAPS-Ⅱ scores combined with LCR at different moments in predicting patient death was analyzed using receiver operating characteristic (ROC) curve. Results Twelve patients fell off, and 37 died in the remaining 176 patients, the mortality rate was 21.02%. The age, temperature, random blood glucose, blood urea nitrogen, serum creatinine, and SAPS- Ⅱ scores in the death group were significantly higher than those in the survival group (P<0.05), while platelet count and LCR at all moments were significantly lower than those in the survival group (P<0.05). The LCR of the death group continued to decrease with time. The trend of changes in the survival group were opposite, and the differences in the two groups between each two moments were statistically significant (P<0.05). The SAPS-Ⅱ scores and LCR at all moments were risk factors for patient death (P<0.05). The SAPS-Ⅱ score and LCR at all moments had predictive value for patient death, and the area under ROC curve of the combined prediction was 0.921 (95%CI 0.825 - 1.000), which was higher than the individual prediction and LCR at each moment combined with SAPS II score prediction (P<0.05). Conclusion The SAPS-Ⅱ scores and LCR at different moments are all related to death of sepsis patients, and the combined prediction of death by the above indicators is highly effective.

Citation： JIANG Xuejiao, ZHANG Fengxiang. Prediction of mortality in sepsis patients using simplified acute physiology score Ⅱ score combined with lactate clearance rates at different moments. Chinese Journal of Respiratory and Critical Care Medicine, 2023, 22(9): 629-633. doi: 10.7507/1671-6205.202306032 Copy

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2.	徐靜媛, 邱海波. 膿毒癥治療的現狀與展望. 國際流行病學傳染病學雜志, 2021, 48(4): 259-262.
3.	李曉丹, 馬青變. 2019~2020年膿毒癥研究領域熱點回顧. 中國急救醫學, 2021, 41(1): 21-27.
4.	胡暢, 胡波, 李志峰, 等. 四種評分系統對膿毒癥患者ICU死亡風險的預測價值比較. 南方醫科大學學報, 2020, 40(4): 513-518.
5.	Lee SG, Song J, Park DW, et al. Prognostic value of lactate levels and lactate clearance in sepsis and septic shock with initial hyperlactatemia: a retrospective cohort study according to the Sepsis-3 definitions. Medicine (Baltimore), 2021, 100(7): e24835.
6.	Blutinger AL, Zollo AM, Weltman J, et al. Prospective evaluation of plasma lactate parameters for prognosticating dogs with shock. J Vet Emerg Crit Care (San Antonio), 2021, 31(3): 351-359.
7.	Moon JI, Shin J, Hwang JH, et al. Impact of left ventricular function on tissue perfusion and renal outcomes in patients with sepsis. Clin Nephrol, 2021, 95(5): 247-255.
8.	肖巖, 楊愛國. 重癥膿毒血癥患兒血乳酸水平變化及其與凝血功能異常的關系. 血栓與止血學, 2022, 28(2): 248-249.
9.	中國醫師協會急診醫師分會, 中國研究型醫院學會休克與膿毒癥專業委員會. 中國膿毒癥/膿毒性休克急診治療指南(2018). 感染、炎癥、修復, 2019, 20(1): 3-22.
10.	韓天勇, 程濤, 何亞榮, 等. 急性生理學評分對老年膿毒癥患者院內死亡風險的預測價值. 醫學研究雜志, 2022, 51(2): 33-37.
11.	Deng C, Zhao L, Yang Z, et al. Targeting HMGB1 for the treatment of sepsis and sepsis-induced organ injury. Acta Pharmacol Sin, 2022, 43(3): 520-528.
12.	Almalki WH. The sepsis induced defective aggravation of immune cells: a translational science underling chemico-biological interactions from altered bioenergetics and/or cellular metabolism to organ dysfunction. Mol Cell Biochem, 2021, 476(6): 2337-2344.
13.	林孟相, 魏宏建, 付春來, 等. 膿毒癥患者血小板膜糖蛋白CD62p和CD63的表達及其臨床意義. 中國呼吸與危重監護雜志, 2007, 6(3): 205-207,229.
14.	Ravikumar N, Sayed MA, Poonsuph CJ, et al. Septic cardiomyopathy: from basics to management choices. Curr Probl Cardiol, 2021, 46(4): 100767.
15.	Kudo D, Goto T, Uchimido R, et al. Coagulation phenotypes in sepsis and effects of recombinant human thrombomodulin: an analysis of three multicentre observational studies. Crit Care, 2021, 25(1): 114.
16.	伊孫邦, 胡雨峰, 林素涵, 等. 不同時間段血乳酸水平對膿毒癥院內死亡的預測價值比較: 基于重癥監護醫學信息數據庫. 中華危重癥醫學雜志(電子版), 2020, 13(1): 39-43.
17.	沈瑞環, 王旭, 魯中原. 疾病嚴重程度評分在心臟術后膿毒癥診斷及遠期預后預測中的價值. 中國胸心血管外科臨床雜志, 2022, 29(2): 219-227.
18.	Vincent JL, Bakker J. Blood lactate levels in sepsis: in 8 questions. Curr Opin Crit Care, 2021, 27(3): 298-302.

1. Tindal EW, Armstead BE, Monaghan SF, et al. Emerging therapeutic targets for sepsis. Expert Opin Ther Targets, 2021, 25(3): 175-189.
2. 徐靜媛, 邱海波. 膿毒癥治療的現狀與展望. 國際流行病學傳染病學雜志, 2021, 48(4): 259-262.
3. 李曉丹, 馬青變. 2019~2020年膿毒癥研究領域熱點回顧. 中國急救醫學, 2021, 41(1): 21-27.
4. 胡暢, 胡波, 李志峰, 等. 四種評分系統對膿毒癥患者ICU死亡風險的預測價值比較. 南方醫科大學學報, 2020, 40(4): 513-518.
5. Lee SG, Song J, Park DW, et al. Prognostic value of lactate levels and lactate clearance in sepsis and septic shock with initial hyperlactatemia: a retrospective cohort study according to the Sepsis-3 definitions. Medicine (Baltimore), 2021, 100(7): e24835.
6. Blutinger AL, Zollo AM, Weltman J, et al. Prospective evaluation of plasma lactate parameters for prognosticating dogs with shock. J Vet Emerg Crit Care (San Antonio), 2021, 31(3): 351-359.
7. Moon JI, Shin J, Hwang JH, et al. Impact of left ventricular function on tissue perfusion and renal outcomes in patients with sepsis. Clin Nephrol, 2021, 95(5): 247-255.
8. 肖巖, 楊愛國. 重癥膿毒血癥患兒血乳酸水平變化及其與凝血功能異常的關系. 血栓與止血學, 2022, 28(2): 248-249.
9. 中國醫師協會急診醫師分會, 中國研究型醫院學會休克與膿毒癥專業委員會. 中國膿毒癥/膿毒性休克急診治療指南(2018). 感染、炎癥、修復, 2019, 20(1): 3-22.
10. 韓天勇, 程濤, 何亞榮, 等. 急性生理學評分對老年膿毒癥患者院內死亡風險的預測價值. 醫學研究雜志, 2022, 51(2): 33-37.
11. Deng C, Zhao L, Yang Z, et al. Targeting HMGB1 for the treatment of sepsis and sepsis-induced organ injury. Acta Pharmacol Sin, 2022, 43(3): 520-528.
12. Almalki WH. The sepsis induced defective aggravation of immune cells: a translational science underling chemico-biological interactions from altered bioenergetics and/or cellular metabolism to organ dysfunction. Mol Cell Biochem, 2021, 476(6): 2337-2344.
13. 林孟相, 魏宏建, 付春來, 等. 膿毒癥患者血小板膜糖蛋白CD62p和CD63的表達及其臨床意義. 中國呼吸與危重監護雜志, 2007, 6(3): 205-207,229.
14. Ravikumar N, Sayed MA, Poonsuph CJ, et al. Septic cardiomyopathy: from basics to management choices. Curr Probl Cardiol, 2021, 46(4): 100767.
15. Kudo D, Goto T, Uchimido R, et al. Coagulation phenotypes in sepsis and effects of recombinant human thrombomodulin: an analysis of three multicentre observational studies. Crit Care, 2021, 25(1): 114.
16. 伊孫邦, 胡雨峰, 林素涵, 等. 不同時間段血乳酸水平對膿毒癥院內死亡的預測價值比較: 基于重癥監護醫學信息數據庫. 中華危重癥醫學雜志(電子版), 2020, 13(1): 39-43.
17. 沈瑞環, 王旭, 魯中原. 疾病嚴重程度評分在心臟術后膿毒癥診斷及遠期預后預測中的價值. 中國胸心血管外科臨床雜志, 2022, 29(2): 219-227.
18. Vincent JL, Bakker J. Blood lactate levels in sepsis: in 8 questions. Curr Opin Crit Care, 2021, 27(3): 298-302.

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Prediction of mortality in sepsis patients using simplified acute physiology score Ⅱ score combined with lactate clearance rates at different moments

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