NỒNG ĐỘ LACTATE MÁU TRONG DỰ ĐOÁN KẾT CỤC NỘI VIỆN CỦA BỆNH NHÂN ĐỢT CẤP BỆNH PHỔI TẮC NGHẼN MẠN TÍNH

Abstract

Backgrounds: Chronic obstructive pulmonary disease (COPD) with its exacerbations is one of the leading causes of death globally. The association between serum lactate and clinical outcomes in patients with acute COPD exacerbation have been investigated in several studies recently. Elevated serum lactate levels might be a predictor of poor prognosis in these patients. Objective: This study aimed to determine the cut-off point and explore the value of serum lactate level in predicting in-hospital outcomes of patients with acute COPD exacerbation. Methods: A cohort study of 136 patients with acute COPD exacerbation was conducted in Emergency Department and Respiratory Department of Cho Ray Hospital from March 2024 to August 2024. Results: The mean age of the patients was 69.8 ± 11.1 years, with the majority being male (90,4%) and 72,1% having a history of smoking. Most patients had moderate to severe acute COPD exacerbations (99,3%). The median lactate level was 2,0 (IQR 1,3 - 2,7) mmol/L and half of our patients had elevated lactate level. There were no significant differences in ages, sexes,BMI, CRP and fever between high lactate level (HLL) and non - HLL groups. The mean heart rate, blood glucose level, and neutrophil/lymphocyte ratio were significantly higher in HLL than non - HLL group (p<0,05). The optimal cut-off point of lactate level to predict in-hospital mortality is 2,0 mmol/L, AUC is 0,84 (95% CI 0,77 - 0,9), p<0,05), sensitivity 93,5%, specificity 62,5%. In predicting requiring ventilation outcome, the optimal cut-off point of lactate level is 1,7 mmol/L, AUC is 0,94 (95% CI 0,89 - 0,98), p<0,05), sensitivity 94,7%, specificity 81,7%. High lactate level was an independent predictor of in-hospital outcomes and patients having high blood lactate had a 7,44 times higher risk of mortality than patients without high blood lactate (OR = 7,44, p = 0,018). Conclusion: Serum lactate is remarkably associated with in-hospital outcomes including ventilation requirement and mortality in patients with AECOPD. Blood lactate levels are not only an important predictor of in-hospital outcomes, but are also easy to access and monitor.