Application of blood lactic acid and Acute Physiology and Chronic Health Evaluation Ⅱ score in evaluation of prognosis of trauma patients_West China Medical Journal

Authors：

CHEN Xin , HUANG Jing , BAI Xiaocui , WANG Lin , LIU Hongmei , ZHANG Wei ,  NIE Shinan

Department of Emergency Medicine, Nanjing General Hospital of Nanjing Military Command, Nanjing, Jiangsu 210002, P. R. China;

Corresponding author：

NIE Shinan, Email: shn_nie@sina.com

Keywords：

Lactic acid; Trauma; Acute Physiology and Chronic Health Evaluation Ⅱ score; Prognosis

DOI：

10.7507/1002-0179.201705087

Video：

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Objective To investigate the correlation between the initial arterial blood lactic acid and Acute Physiology and Chronic Health Evaluation (APACHE) Ⅱ score in trauma patients and its value in prognosis. Methods From August 1st 2015 to July 31st 2016, the clinical data of trauma patients treated in Department of Emergency were analyzed retrospectively. All patients were divided into survival group and death group by observing 28-day prognosis. We compared the relationship between the initial blood lactate level and APACHEⅡ score, and analyzed the relationship between the above indexes and the prognosis of the patients. Results A total of 743 patients were enrolled, with692 in survival group and 51 in death group.The APACHEⅡ score and initial blood lactate level in the survival group [(9.93±4.62) points, (2.02±1.44) mmol/L] were significantly lower than those in the death group [(22.84±7.26) points, (4.60±3.69) mmol/L] with significant differences (t=18.20, 9.77; P<0.01). The APACHEⅡ score and the mortality rate of patients with lactic acid level >4 mmol/L were significantly higher than those of patients with lactic acid of 2-4 mmol/L and <2 mmol/L; the differences were significant (P<0.05). The blood lactate and mortality in patients with APACHEⅡ score >20 were significantly higher than those in the patients with ≤10 and 11-20; the differences were significant (P<0.05). There was a significant positive correlation between initial blood lactate level and APACHEⅡ score (r=0.426, P<0.01). Conclusions The initial blood lactate level and APACHEⅡ score of trauma patients are correlated with the severity of injury and mortality. Both of the increase of initial blood lactic acid level and APACHEⅡ score suggest the risk of death in trauma patients.

Citation： CHEN Xin, HUANG Jing, BAI Xiaocui, WANG Lin, LIU Hongmei, ZHANG Wei, NIE Shinan. Application of blood lactic acid and Acute Physiology and Chronic Health Evaluation Ⅱ score in evaluation of prognosis of trauma patients. West China Medical Journal, 2017, 32(6): 819-823. doi: 10.7507/1002-0179.201705087 Copy

1.	Jansen TC, Van Bommel J, Bakker J. Blood lactate monitoring in critically ill patients: a systematic health technology assessment. Crit Care Med, 2009, 37(10): 2827-2839.
2.	Broder G, Weil MH. Excess lactate: an index of reversibility of shock in human patients. Science, 1964, 143(3613): 1457-1459.
3.	江学成. 危重疾病严重程度评分临床应用和意义. 中国危重病急救医学, 2000, 12(4): 195-197.
4.	Knaus WA, Zimmerman JE, Wagner DP, et al. APACHE-acute physiology and chronic health evaluation: a physiologically based classification system. Crit Care Med, 1981, 9(8): 591-597.
5.	陈捷, 黄淑芬, 程小芸, 等. APACHE Ⅱ评分在严重创伤骨科患者的评估及分级护理中的应用. 创伤外科杂志, 2012, 14(5): 458, 466.
6.	Joe BH, Jo U, Kim HS, et al. APACHE Ⅱ score, rather than cardiac function, may predict poor prognosis in patients with stress-induced cardiomyopathy. J Korean Med Sci, 2012, 27(1): 52-57.
7.	Rhee JY, Kwon KT, Ki HK, et al. Scoring systems for prediction of mortality in patients with intensive care unit-acquired sepsis: a comparison of the pitt bacteremia score and the acute physiology and chronic health evaluationⅡ scoring systems. Shock, 2009, 31(2): 146-150.
8.	De Freitas ER. Profile and severity of the patients of intensive care units: prospective application of the APACHE Ⅱ index. Rev Lat Am Enfermagem, 2010, 18(3): 317-323.
9.	范学朋, 柳梅, 尚小珂, 等. APACHEⅡ评分与危重患者血糖控制目标值的关系. 中国急救医学, 2013, 33(10): 921-924.
10.	Stachon A, Segbers E, Hering S, et al. A laboratory-based risk score for medical intensive care patients. Clin Chem Lab Med, 2008, 46(6): 855-862.
11.	Hwabejire JO, Jin G, Imam AM, et al. Pharmacologic modulation of cerebral metabolic derangement and excitotoxicity in a porcine model of traumatic brain injury and hemorrhagic shock. Surgery, 2013, 154(2): 234-243.
12.	Jin G, DeMoya MA, Duggan M, et al. Traumatic brain injury and hemorrhagic shock: evaluation of different resuscitation strategies in a large animal model of combined insults. Shock, 2012, 38(1): 49-56.
13.	Zhao QJ, Zhang XG, Wang LX. Mild hypothermia therapy reduces blood glucose and lactate and improves neurologic outcomes in patients with severe traumatic brain injury. J Crit Care, 2011, 26(3): 311-315.
14.	Tisherman SA, Barie P, Bokhari F, et al. Clinical practice guideline: endpoints of resuscitation. J Trauma, 2004, 57(4): 898-912.
15.	Spahn DR, Bouillon B, Cerny V, et al. Management of bleeding and coagulopathy following major trauma: an updated European guideline. Crit Care, 2013, 17(2): R76.
16.	高伟波, 曹宝平, 陈子涛, 等. 乳酸和乳酸清除率对危重病患者预后的意义. 中华急诊医学杂志, 2012, 21(12): 1358-1362.
17.	Cusack RJ, Rhodes A, Lochhead P, et al. The strong ion gap does not have prognostic value in critically ill patients in a mixed medical/surgical adult ICU. Intensive Care Med, 2002, 28(7): 864-869.
18.	Meregalli A, Oliveira RP, Friedman G. Occult hypoperfusion is associated with increased mortality in hemodynamically stable, high-risk, surgical patients. Crit Care, 2004, 8(2): R60-R65.
19.	管向东, 李小悦. 应重视严重创伤和围术期血乳酸的监测. 中华普通外科学文献: 电子版, 2010, 4(4): 299-300.
20.	Grey B, Rodseth RN, Muckart DJ. Early fracture stabilisation in the presence of subclinical hypoperfusion. Injury, 2013, 44(2): 217-220.
21.	Dossett LA, Redhage LA, Sawyer RG, et al. Revisiting the validity of APACHE Ⅱ in the trauma ICU: improved risk stratification in critically injured adults. Injury, 2009, 40(9): 993-998.
22.	朱睿瑶, 张迪, 冯丽芝, 等. 血乳酸、胆碱脂酶与 APACHE Ⅱ评分在评估危重症患者病情预后中的研究. 医学研究杂志, 2014, 43(3): 65-67.

1. Jansen TC, Van Bommel J, Bakker J. Blood lactate monitoring in critically ill patients: a systematic health technology assessment. Crit Care Med, 2009, 37(10): 2827-2839.
2. Broder G, Weil MH. Excess lactate: an index of reversibility of shock in human patients. Science, 1964, 143(3613): 1457-1459.
3. 江学成. 危重疾病严重程度评分临床应用和意义. 中国危重病急救医学, 2000, 12(4): 195-197.
4. Knaus WA, Zimmerman JE, Wagner DP, et al. APACHE-acute physiology and chronic health evaluation: a physiologically based classification system. Crit Care Med, 1981, 9(8): 591-597.
5. 陈捷, 黄淑芬, 程小芸, 等. APACHE Ⅱ评分在严重创伤骨科患者的评估及分级护理中的应用. 创伤外科杂志, 2012, 14(5): 458, 466.
6. Joe BH, Jo U, Kim HS, et al. APACHE Ⅱ score, rather than cardiac function, may predict poor prognosis in patients with stress-induced cardiomyopathy. J Korean Med Sci, 2012, 27(1): 52-57.
7. Rhee JY, Kwon KT, Ki HK, et al. Scoring systems for prediction of mortality in patients with intensive care unit-acquired sepsis: a comparison of the pitt bacteremia score and the acute physiology and chronic health evaluationⅡ scoring systems. Shock, 2009, 31(2): 146-150.
8. De Freitas ER. Profile and severity of the patients of intensive care units: prospective application of the APACHE Ⅱ index. Rev Lat Am Enfermagem, 2010, 18(3): 317-323.
9. 范学朋, 柳梅, 尚小珂, 等. APACHEⅡ评分与危重患者血糖控制目标值的关系. 中国急救医学, 2013, 33(10): 921-924.
10. Stachon A, Segbers E, Hering S, et al. A laboratory-based risk score for medical intensive care patients. Clin Chem Lab Med, 2008, 46(6): 855-862.
11. Hwabejire JO, Jin G, Imam AM, et al. Pharmacologic modulation of cerebral metabolic derangement and excitotoxicity in a porcine model of traumatic brain injury and hemorrhagic shock. Surgery, 2013, 154(2): 234-243.
12. Jin G, DeMoya MA, Duggan M, et al. Traumatic brain injury and hemorrhagic shock: evaluation of different resuscitation strategies in a large animal model of combined insults. Shock, 2012, 38(1): 49-56.
13. Zhao QJ, Zhang XG, Wang LX. Mild hypothermia therapy reduces blood glucose and lactate and improves neurologic outcomes in patients with severe traumatic brain injury. J Crit Care, 2011, 26(3): 311-315.
14. Tisherman SA, Barie P, Bokhari F, et al. Clinical practice guideline: endpoints of resuscitation. J Trauma, 2004, 57(4): 898-912.
15. Spahn DR, Bouillon B, Cerny V, et al. Management of bleeding and coagulopathy following major trauma: an updated European guideline. Crit Care, 2013, 17(2): R76.
16. 高伟波, 曹宝平, 陈子涛, 等. 乳酸和乳酸清除率对危重病患者预后的意义. 中华急诊医学杂志, 2012, 21(12): 1358-1362.
17. Cusack RJ, Rhodes A, Lochhead P, et al. The strong ion gap does not have prognostic value in critically ill patients in a mixed medical/surgical adult ICU. Intensive Care Med, 2002, 28(7): 864-869.
18. Meregalli A, Oliveira RP, Friedman G. Occult hypoperfusion is associated with increased mortality in hemodynamically stable, high-risk, surgical patients. Crit Care, 2004, 8(2): R60-R65.
19. 管向东, 李小悦. 应重视严重创伤和围术期血乳酸的监测. 中华普通外科学文献: 电子版, 2010, 4(4): 299-300.
20. Grey B, Rodseth RN, Muckart DJ. Early fracture stabilisation in the presence of subclinical hypoperfusion. Injury, 2013, 44(2): 217-220.
21. Dossett LA, Redhage LA, Sawyer RG, et al. Revisiting the validity of APACHE Ⅱ in the trauma ICU: improved risk stratification in critically injured adults. Injury, 2009, 40(9): 993-998.
22. 朱睿瑶, 张迪, 冯丽芝, 等. 血乳酸、胆碱脂酶与 APACHE Ⅱ评分在评估危重症患者病情预后中的研究. 医学研究杂志, 2014, 43(3): 65-67.

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