脓毒症休克患者早期乳酸清除率与28天 全因病死率的相关性分析

Correlation Analysis between Early Lactate Clearance Rate and 28-Day All-Cause Mortality in Patients with Septic Shock

摘要: 目的：探讨新疆医科大学第六附属医院重症医学科(ICU)收治的脓毒症休克患者早期乳酸清除率与28天全因病死率的相关性，为临床评估患者预后、优化治疗策略提供参考依据。方法：回顾性收集2022年1月至2026年1月期间新疆医科大学第六附属医院ICU收治的脓毒症休克患者的临床资料，根据Sepsis-3定义筛选研究对象，排除不符合纳入标准、临床资料缺失及随访失败的患者。收集患者一般资料、入院时生命体征、实验室检查指标(入院时及入院6 h乳酸水平、血常规、肝肾功能、凝血功能等)、基础疾病、感染部位、治疗措施及28天生存情况。计算早期(6 h)乳酸清除率，根据乳酸清除率中位数将患者分为高乳酸清除率组(≥中位数)和低乳酸清除率组(<中位数)，比较两组患者的临床特征及28天全因病死率。采用Kaplan-Meier法绘制生存曲线，Log-rank检验比较两组生存差异；采用单因素及多因素Logistic回归分析探讨脓毒症休克患者28天全因病死率的影响因素，重点分析早期乳酸清除率与28天全因病死率的相关性。结果：共纳入82例脓毒症休克患者，其中男性48例(58.5%)，女性34例(41.5%)，年龄(62.1 ± 15.9)岁。早期乳酸清除率中位数为26.8%，其中高乳酸清除率组41例(50.0%)，低乳酸清除率组41例(50.0%)。低乳酸清除率组28天全因病死率(46.3%)显著高于高乳酸清除率组(24.4%)，差异有统计学意义(P < 0.05)。Kaplan-Meier生存分析显示，高乳酸清除率组28天生存率显著高于低乳酸清除率组(Log-rank χ² = 8.925, P < 0.01)。单因素分析显示，年龄、APACHEII评分、SOFA评分、入院时乳酸水平、早期乳酸清除率、感染性休克持续时间、机械通气时间、是否合并多器官功能障碍综合征(MODS)与脓毒症休克患者28天全因病死率相关(P均<0.05)。多因素Logistic回归分析显示，早期乳酸清除率降低(OR = 0.951, 95% CI: 0.926~0.977, P < 0.001)、APACHEII评分升高(OR = 1.102, 95% CI: 1.056~1.150, P < 0.001)、合并MODS (OR = 3.208, 95% CI: 1.672~6.156, P < 0.001)是脓毒症休克患者28天全因病死率的独立危险因素。结论：新疆医科大学第六附属医院ICU收治的脓毒症休克患者中，早期乳酸清除率与28天全因病死率密切相关，早期乳酸清除率降低提示患者预后不良，可作为评估脓毒症休克患者短期预后的重要临床指标，指导临床优化复苏治疗策略。

Abstract: Objective: To explore the correlation between early lactate clearance rate and 28-day all-cause mortality in patients with septic shock admitted to the Intensive Care Unit (ICU) of the Sixth Affiliated Hospital of Xinjiang Medical University, so as to provide a reference for clinical evaluation of patients’ prognosis and optimization of treatment strategies. Methods: The clinical data of patients with septic shock admitted to the ICU of the Sixth Affiliated Hospital of Xinjiang Medical University from January 2022 to January 2026 were retrospectively collected. Study subjects were screened according to the Sepsis-3 definition, and patients who did not meet the inclusion criteria, had missing clinical data or failed follow-up were excluded. General information, vital signs on admission, laboratory examination indicators (lactate levels on admission and 6 hours after admission, blood routine, liver and kidney function, coagulation function, etc.), underlying diseases, infection sites, treatment measures and 28-day survival status of the patients were collected. The early (6-hour) lactate clearance rate was calculated. Patients were divided into a high lactate clearance rate group (≥median) and a low lactate clearance rate group (χ² = 8.925, P < 0.01). Univariate analysis showed that age, APACHEII score, SOFA score, lactate level on admission, early lactate clearance rate, duration of septic shock, duration of mechanical ventilation, and whether complicated with multiple organ dysfunction syndrome (MODS) were correlated with 28-day all-cause mortality in patients with septic shock (all P < 0.05). Multivariate Logistic regression analysis showed that decreased early lactate clearance rate (OR = 0.951, 95% CI: 0.926~0.977, P < 0.001), increased APACHEII score (OR = 1.102, 95% CI: 1.056~1.150, P < 0.001), and complicated with MODS (OR = 3.208, 95% CI: 1.672~6.156, P < 0.001) were independent risk factors for 28-day all-cause mortality in patients with septic shock. Conclusion: Among patients with septic shock admitted to the ICU of the Sixth Affiliated Hospital of Xinjiang Medical University, early lactate clearance rate is closely correlated with 28-day all-cause mortality. Decreased early lactate clearance rate indicates poor prognosis of patients, which can be used as an important clinical indicator to evaluate the short-term prognosis of patients with septic shock and guide clinical optimization of resuscitation treatment strategies.