乳酸清除率联合SOFA评分对脓毒性休克患者短期预后的预测价值

Predictive Value of Lactate Clearance Rate Combined with SOFA Score for Short-Term Prognosis in Patients with Septic Shock

摘要: 目的：探究乳酸清除率(LCR)联合序贯器官衰竭评估(SOFA)评分对脓毒性休克患者短期预后的预测价值。方法：选取2023年1月至2025年6月收治的100例脓毒性休克患者为研究对象。根据28 d预后情况分为生存组(n = 54)与死亡组(n = 46)。记录患者性别、年龄、BMI、基础疾病、感染部位、实验室指标、急性生理学与慢性健康状况评估II (APACHE II)、SOFA评分等。记录2组患者入院时(0 h)、入院6 h、入院24 h的乳酸(Lac)值，并计算6 h及24 h LCR。利用Logistic回归分析筛选预测脓毒性休克患者预后的独立因素，并绘制ROC曲线，分析LCR联合SOFA评分预测患者预后的曲线下面积(AUC)。结果：死亡组年龄、SOFA评分、PLT、Lac0h、Lac6h、Lac24h、6 h LCR、24 h LCR显著高于生存组(均P < 0.05)，Logistic回归结果显示SOFA评分、24 h LCR为患者预后的独立预测因子，SOFA评分预测脓毒性休克患者预后的AUC为0.680，24 h LCR预测脓毒性休克患者预后的AUC为0.800，两者联合预测脓毒性休克患者预后的AUC为0.822。结论：在脓毒性休克患者中，SOFA评分、24 h LCR是影响其短期预后的独立危险因素；入院后24 h LCR联合SOFA评分预测脓毒性休克预后的准确性优于单个变量，具有较好的预测价值。

Abstract: Objective: To explore the predictive value of lactate clearance rate (LCR) combined with Sequential Organ Failure Assessment (SOFA) score for short-term prognosis in patients with septic shock. Methods: A total of 100 patients with septic shock admitted from January 2023 to June 2025 were selected as the research subjects. They were divided into the survival group (n = 54) and the death group (n = 46) based on their 28-day prognosis. Data including patients’ gender, age, body mass index (BMI), underlying diseases, infection sites, laboratory indicators, Acute Physiology and Chronic Health Evaluation II (APACHE II) score, and SOFA score were recorded. The lactate (Lac) levels of patients in both groups were measured at admission (0 h), 6 hours after admission, and 24 hours after admission; the 6-hour LCR and 24-hour LCR were then calculated. Logistic regression analysis was used to screen for independent factors predicting the prognosis of patients with septic shock. Receiver Operating Characteristic (ROC) curves were plotted, and the area under the curve (AUC) of LCR combined with SOFA score for predicting patient prognosis was analyzed. Results: Compared with the survival group, the death group had significantly higher age, SOFA score, platelet count (PLT), Lac level at admission (Lac0h), Lac level at 6 hours after admission (Lac6h), Lac level at 24 hours after admission (Lac24h), 6-hour LCR, and 24-hour LCR (all P < 0.05). Logistic regression results showed that SOFA score and 24-hour LCR were independent predictors of patient prognosis. The AUC of SOFA score for predicting the prognosis of patients with septic shock was 0.680, the AUC of 24-hour LCR was 0.800, and the AUC of the combination of the two was 0.822. Conclusion: In patients with septic shock, SOFA score and 24-hour LCR are independent risk factors affecting their short-term prognosis. The combination of 24-hour LCR (after admission) and SOFA score has higher accuracy in predicting the prognosis of septic shock than either indicator alone, and thus exhibits good predictive value.