STABİL KOAH OLGULARINDA PLAZMA LAKTAT DÜZEYİ

Amaç Morbidite ve mortalitesi yüksek olan KOAH’da, prognostik belirteçlerin saptanması önemlidir. Plazma laktat düzeyi, doku oksijen ihtiyacını gösteren ve kolay ulaşılabilen bir tetkiktir. Çalışmamızın amacı; stabil KOAH olgularında plazma laktat düzeyi ile GOLD KOAH kategorisi, FEV1, ataklar ve hipoksemi arasındaki ilişkiyi incelemektir. Gereç ve Yöntem Göğüs Hastalıkları Polikliniği’ne başvuran stabil dönemdeki KOAH olguları retrospektif olarak değerlendirildi. Demografik özellikler, arter kan gazı analizleri, yıllık atak sayıları, GOLD KOAH kategorisine göre; A,B,C,D sınıfları, spirometrik parametreler, evde uzun süreli oksijen tedavisi (USOT) ve non-invaziv mekanik ventilasyon (NİMV) kullanıp kullanmadıkları kaydedildi. Bulgular Toplam 103 stabil KOAH olgusu (E/K: 90/13, ortalama yaş: 66.8±8.0/yıl) çalışmaya dahil edildi. Olguların FEV1:%45.7±20.2, FVC:%63.5±22.2, Pa- O2:66.3±15.0mmHg, PaCO2:43.9±8.3mmHg, laktat: 1.5±0.6 mmol/L idi. On iki olgu(%11.7) A, 16 olgu (%15.5) B, 25 olgu (%24.3) C, 50 olgu (%48.5) D grubunda idi. Olguların %47.6’sı (n=49) USOT, %37.3’ü (n=28) NİMV kullanmakta idi. D kategorisindeki olgularda laktat düzeyi A, B, C sınıflarına göre belirgin yüksekti (p<0.001). USOT kullananlarda kullanmayanlara göre; laktat düzeyi ve PaCO2 belirgin yüksekti (sırasıyla 1.7±0.7 vs. 1.3±0.5, p<0.001, 47.9±9.4 vs. 40.2±4.8, p<0.001). Laktat düzeyi ile FEV1 (%) arasında negatif korelasyon mevcuttu (r=-0.32, p=0.001). Laktat düzeyi, yıllık atak sayısı ≥2 olanlar ve KOAH atak nedeniyle hastane yatışı olanlarda anlamlı olarak yüksekti (1.6±0.6 vs 1.2±0.5, p=0.002).Ağır şiddetteki KOAH’ı öngörmede plazma laktat düzeyinin 1.45mmol/L’nin üzerinde olmasının spesifitesi %68, sensitivitesi %64 olarak saptandı. Sonuç Plazma laktat düzeyi, KOAH kategorisi D olan ve USOT kullanan olgularda yüksek saptanmıştır. Plazma laktat düzeyinin KOAH’da prognostik öneminin olup olmadığının saptanması için konuyla ilgili prospektif çalışmaların yapılmasına ihtiyaç vardır.

Anahtar Kelimeler:

GOLD, KOAH, laktat düzeyi

LACTATE LEVEL IN STABLE COPD PATIENTS

Objective Lactate level is an indicator of tissue oxygenation. It might be valuable for COPD patients to have a prognostic marker. Thus, we aimed to evaluate the relationship between lactate level and COPD classification, FEV1 level, exacerbations, hypoxemia in stable COPD patients. Materials and Methods In this retrospective study, demographics, arterial blood gas analysis, exacerbation history, GOLD classification, pulmonary function tests, long-term oxygen therapy (LTOT) and non-invasive mechanical ventilation (NIMV) usage in stable COPD patients were recorded. Results Totally 103 patients (M / F: 90/13, mean age: 66.8 ± 8.0years) were included. Mean FEV1:45±20%, FVC: 63±22%, PaO2:66±15mmHg, PaCO2:43±8mmHg, lactate level: 1.5±0.6mmol/L. The groups of the patients according to GOLD COPD classification were as follows;; 11.7%, 15.5%, 24.3%, 48.5% in A,B,C,D, respectively. Of patients 47.6% were using LTOT and 37.3% were using NIMV. Lactate level of the patients in category D was significantly higher than the patients in A, B, C categories (p<0.001). Lactate level and PaCO2was significantly higher in patients who used LTOT (1.7±0.7 vs. 1.3±0.5 p<0.001, 47.9±9.4 vs. 40.2±4.8 p<0.001, respectively). There was a negative correlation between lactate level and FEV1 (r=-0.32, p=0.001). Lactate level was significantly higher in patients who had moderate or severe exacerbation history (≥2 or ≥1 hospitalization) (p=0.002). Lactate level above 1.45mmol/L showed 68% specificity and 64% sensitivity for predicting severe COPD. Conclusion Lactate level is increased in patients with GOLD category D and LTOT usage. Prospective studies are required to determine whether lactate level has prognostic significance in COPD.

Keywords:

GOLD, COPD, lactate level,

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Referans 1: Neumeier A, Keith R. Clinical Guideline Highlights for the Hospitalist: The GOLD and NICE Guidelines for the Management of COPD. J Hosp Med. 2020;15(4):240-41.
Referans 2: Global Strategy for the Diagnosis, Management and Prevention of COPD, Global Initiative for Chronic Obstructive Lung Disease (GOLD) 2020. Available from: http://www.goldcopd.org/
Referans 3: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):2827–39
Referans 4: Crawford SO, Ambrose MS, Hoogeveen RC, Brancati FL, Ballantyne CM, Young JH. Association of lactate with blood pressure before and after rapid weight loss. Am J Hypertens. 2008; 21(12):1337–42.
Referans 5: Zagari F, Jordan M, Stettler M, Zagari F, Jordan M, Stettler M, Broly H, Wurm FM. Lactate metabolism shift in CHO cell culture: the role of mitochondrial oxidative activity. N Biotechnol. 2013; 30(2):238–45.
Referans 6:Shapiro NI, Trzeciak S, Hollander JE, Birkhahn R, Otero R, Osborn TM, et al. A prospective, multicenter derivation of a biomarker panel to assess risk of organ dysfunction, shock, and death in emergency department patients with suspected sepsis. Crit Care Med. 2009; 37(1):96-104
Referans 7:Vincent JL, Quintairos E Silva A, Couto Jr L, Taccone FS. The value of blood lactate kinetics in critically ill patients: a systematic review. Crit Care 2016; 20(1):257.
Referans 8: Zhang Z, Xu X. Lactate clearance is a useful biomarker for the prediction of all-cause mortality in critically ill patients: a systematic review and meta-analysis. Crit Care Med 2014; 42(9):2118–25.
Referans 9: Haas SA, Lange T, Saugel B, Petzoldt M, Fuhrmann V, Metschke M, et al. Severe hyperlactatemia, lactate clearance and mortality in unselected critically ill patients. Intensive Care Med. 2016; 42(2):202–10
Referans 10: Galić K, Pravdić D, Prskalo Z, Kukulj S, Starčević B, Vukojević M. Prognostic value of lactates in relation to gas analysis and acid-base status in patients with pulmonary embolism. Croat Med J. 2018; 59(4):149-55.
Referans 11: Nguyen HB, Rivers EP, Knoblich BP, Jacobsen G, Muzzin A, Ressler JA, et al.Early lactate clearance is associated with improved outcome in severe sepsis and septic shock. Crit Care Med. 2004; 32(8):1637-42
Referans 12: Nichol AD, Egi M, Pettila V, Bellomo R, French C, Hart G, et al. Relative hyperlactatemia and hospital mortality in critically ill patients: a retrospective multi-centre study. Crit Care 2010; 14(1):25.
Referans 13: Durmuş U, Doğan NÖ, Pekdemir M, Yılmaz S, Yaka E, Karadaş A, et al.The value of lactate clearance in admission decisions of patients with acute exacerbation of COPD. Am J Emerg Med. 2018 ; 36(6):972-76
Referans 14:Brasil Santos D, de Assis Viegas CA. Correlation of levels of obstruction in COPD with lactate and six-minute walk test. Rev Port Pneumol. 2009; 15(1):11-25.
Referans 15:Tanaka Y, Hino M, Morikawa T, Takeuchi K, Mizuno K, Kudoh S. Arterial blood lactate is a useful guide to when rehabilitation should be instigated in COPD. Respirology. 2008; 13(4):564-8.
Referans 16:Skjørten I, Hilde JM, Melsom MN, Hisdal J, Hansteen V, Steine K, et al. Exercise capacity in COPD patients with exercise-induced pulmonary hypertension. Int J Chron Obstruct Pulmon Dis. 2018; 13:3599-610.
Referans 17:Quanjer PH, Tammeling GJ, Cotes JE, Pedersen OF, Peslin R, Yemault JC. Lung volumes and forced ventilatory flows.Report working party standardization of lung function tests, European community for steel and coal.Official statement of the European respiratory society. Eur Respir J Suppl. 1993; 16:5–40