乳酸脱氢酶对感染性休克患者预后的评估价值

doi:10.3969/j.issn.1002-1949.2019.03.003

Chinese Journal of Critical Care Medicine

2019, Vol. 39

Issue (3): 211-215 DOI: 10.3969/j.issn.1002-1949.2019.03.003

Predictive value of lactate dehydrogenase in the prognosis of patients with septic shock

Li Hui-Dong, Xing Bo

Department of Emergency, the Second Affiliated Hospital of Hainan Medical University, Haikou 570311, China

Abstract
Figure/Table
References (12)
Related Citation (15)

Download: PDF (905 KB) HTML (1 KB)
Export: BibTeX | EndNote (RIS)

Abstract Objective To explore the value of lactate dehydrogenase (LDH) in the prognostic assessment of patients with septic shock. Methods We used Medical Information Mart for Intensive CareⅢ (MIMIC-Ⅲ) database as data source. The patients with septic shock in the MIMIC-Ⅲ database were extracted according to the diagnostic criteria for septic shock in International Guidelines for Management of Sepsis and Septic Shock: 2016. All clinical data were collected for participants, which mainly included basic data, main underlying disease, sequential organ failure assessment (SOFA) score, laboratory test results, the Intensive Care Unit (ICU) residence time, 30-day and 90-day mortality. All the study patients were divided into two groups according to their serum LDH levels. The patients with normal serum LDH level (LDH< 225 U/L) were enrolled into the normal LDH group, and the patients with elevated LDH level (LDH≥225 U/L ) were enrolled into the elevated LDH group. Clinical characteristics of the two groups were compared. Kaplan-Meier survival curve was performed to analyze 30-day and 90-day cumulative survival rates in two groups. Multivariate Cox regression analysis was done to find the independent risk factors of death in patients with septic shock. Results A total number of 685 patients with septic shock were included. The 30-day and 90-day mortality of the patients with septic shock was 29.3% and 35.3%. Compared with the normal LDH group, the patients in the elevated LDH group were more likely to have chronic heart failure (20.3% vs.35.1%, P<0.01) and had a higher SOFA score ［(6.6±3.8)scores vs.(10.2±3.9)scores, P<0.01］. The proportion of continuous renal replacement therapy (CRRT) and mechanical ventilation increased significantly (1.7% vs.9.0%, 42.4% vs.66.3%, both P<0.01), and the ICU stay time was significantly prolonged ［3.0 (2.0, 7.0)d vs.6.0 (3.0, 13.0)d, P<0.01］, the 30-day and 90-day mortality rate was significantly increased (13.4% vs.34.7%, 16.9% vs.41.5%, both P<0.01). Kaplan-Meier survival curve analysis showed that the 30-day and 90-day cumulative survival rate of the elevated LDH group was significantly lower than that of the normal LDH group (χ2=26.7449, χ2=14.6480, both P<0.01). Cox proportional hazard regression analysis showed that elevated LDH was an independent risk factor for death in patients with septic shock (OR=1.9783, 95%CI=1.5203~2.5743, P<0.001). Conclusion LDH may be a valuable indicator for evaluating the prognosis of patients with septic shock.

Key words： Septic shock Lactate dehydrogenase (LDH) Prognosis

Corresponding Authors: Xing Bo, E-mail: xb36370887@163.com

	Service

	E-mail this article
	Add to my bookshelf
	Add to citation manager
	E-mail Alert
	RSS
	Articles by authors
	Li Hui-Dong
	Xing Bo

Cite this article:

Li Hui-Dong,Xing Bo. Predictive value of lactate dehydrogenase in the prognosis of patients with septic shock[J]. Chinese Journal of Critical Care Medicine, 2019, 39(3): 211-215.

URL:

http://www.cnemergency.org.cn/EN/10.3969/j.issn.1002-1949.2019.03.003 OR http://www.cnemergency.org.cn/EN/Y2019/V39/I3/211

［1］Arts RJ, Gresnigt MS, Joosten LA, et al. Cellular metabolism of myeloid cells in sepsis［J］. J Leukoc Biol， 2017， 101(1):151-164. ［2］Cheng SC, Scicluna BP, Arts RJ, et al. Broad defects in the energy metabolism of leukocytes underlie immunoparalysis in sepsis［J］. Nat Immunol, 2016, 17(4):406-413. ［3］Palsson-McDermott EM, Curtis AM, Goel G, et al. Pyruvate kinase M2 regulates HIF-1α activity and IL-1β induction and is a critical determinant of the Warburg effect in LPS-activated macrophages［J］. Cell Metab， 2015， 21(2):347. ［4］Johnson AE, Stone DJ, Celi LA, et al. The MIMIC Code Repository: enabling reproducibility in critical care research［J］. J Am Med Inform Assoc, 2018, 25(1),32-39. ［5］Freund Y, Lemachatti N, Krastinova E, et al. Prognostic accuracy of sepsis-3 criteria for in-hospital mortality among patients with suspected infection presenting to the emergency department［J］. JAMA, 2017, 317(3):301-308. ［6］Li H, Xiong W, Liu H, et al. Serum LDH level may predict outcome of chronic lymphocytic leukemia patients with a 17p deletion: a retrospective analysis of prognostic factors in China［J］. Chin J Cancer Res, 2017, 29(2):156-165. ［7］Marmorino F, Salvatore L, Barbara C, et al. Serum LDH predicts benefit from bevacizumab beyond progression in metastatic colorectal cancer［J］. Br J Cancer, 2017, 116(3):318-323. ［8］陈都, 陆士奇, 徐峰,等. 血清乳酸脱氢酶早期预测急性胰腺炎继发多器官功能障碍综合征的价值研究［J］. 中国急救医学, 2012, 32(4):349-351. ［9］Lu J, Wei Z, Jiang H, et al.Lactate dehydrogenase is associated with 28-day mortality in patients with sepsis: a retrospective observational study［J］. J Surg Res， 2018， 228:314-321. ［10］Yang L, Xie M, Yang M, et al. PKM2 regulates the Warburg effect and promotes HMGB1 release in sepsis［J］. Nat Commun, 2014, 5:4436. ［11］蒋晓月, 江瑛. 乳酸脱氢酶和Warburg效应的研究进展［J］. 生理科学进展, 2017， 48(5):352-356. ［12］Douglas JJ, Walley KR. Metabolic changes in cardiomyocytes during sepsis［J］. Crit Care, 2013, 17(5):186.