乳酸参数对非静脉曲张性上消化道出血患者急诊死亡和30 d内再出血的预测价值

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Abstract Objective To investigate the value of lactic acid parameters in predicting emergency death and rebleeding within 30 days in patients with nonvariceal upper gastrointestinal bleeding (NVUGIB). Methods Clinical data of 924 adult NVUGIB patients admitted to the the 987th Hospital of PLA Joint logistics Support Force from May 2017 to October 2023 were retrospectively analyzed. The level of intravenous lactate was determined, the initial, highest and average lactate levels were recorded within 24 h after admission, and lactate clearance rate(LCR) was calculated. Study outcomes included death in the emergency department and rebleeding within 30 days after admission. Results The levels of initial lactic acid, maximum lactic acid and average lactic acid in emergency patients were significantly higher than those in survivors(P＜0.05), and the LCR was significantly lower than that in survival group, with statistical significance (P＜0.05). In addition, the LCR of patients with rebleeding within 30 days was significantly lower than that of those without bleeding (P＜0.05). Multivariate logistic regression analysis showed that initial lactic acid, maximum lactic acid, average lactic acid, LCR and AIMS65 scores were independent risk factors for emergency death with NVUGIB (P＜0.05). LCR and AIMS65 scores were independent influencing factors for 30 days of rebleeding in NVUGIB patients (P＜0.05). The area under ROC curve (AUC) of initial lactic acid, maximum lactic acid, average lactic acid and LCR in predicting emergency death of NVUGIB were 0.833(95%CI: 0.763-0.903), 0.813(95%CI: 0.736-0.890), 0.809(95%CI: 0.736-0.890) and 0.766(95%CI: 0.684-0.848), respectively. The AUC of LCR in predicting rebleeding within 30 days in patients with NVUGIB reached 0.844 (95%CI: 0.789-0.899). When the above lactate parameters were combined with AIMS65 score, the prediction ability of the model for the risk of death and rebleeding was improved. Conclusions Elevated lactate levels or decreased LCR are associated with poor prognosis of NVUGIB, and lactate parameters are expected to be an early predictor of NVUGIB emergency death and 30-day rebleeding risk stratification.

Key words： lactic acid lactate clearance rate nonvariceal upper gastrointestinal bleeding emergency death rebleeding within 30 days

Received: 10 June 2024

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	LIANG Junrong
	ZHOU Yongqiang
	HU Kang
	LI Chunyan
	HE Xiaoyi
	LIU Yanjun

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LIANG Junrong,ZHOU Yongqiang,HU Kang等. Value of lactic acid parameters in predicting emergency death and rebleeding within 30 days in patients with nonvariceal upper gastrointestinal bleeding[J]. Med. J. Chin. Peop. Armed Poli. Forc., 2025, 36(4): 325-332.

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https://journal08.magtechjournal.com/Jwk_wjyx/EN/ OR https://journal08.magtechjournal.com/Jwk_wjyx/EN/Y2025/V36/I4/325

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