小儿败血症患者乳酸白蛋白比值与微循环变化的关系-动脉网

Association between the lactate-albumin ratio and microcirculation changes in Pediatric Septic patients

Nature 等信源发布 2024-09-29 02:22



可切换为仅中文







AbstractA lactate/albumin ratio (LAR) greater than 0.5 measured early in the course of pediatric critical illness is associated with greater mortality. Whether the elevated LAR can be explained by microcirculation disorders in children with sepsis is not known. In this longitudinal retrospective study (January 2021-January 2024), serum albumin and lactate were measured on admission to the pediatric intensive care unit (PICU), with sublingual video microscopy performed simultaneously to measure microcirculation.

摘要在小儿危重病早期测量的乳酸/白蛋白比率（LAR）大于0.5与更高的死亡率相关。。在这项纵向回顾性研究（2021年1月至2024年1月）中，在儿科重症监护病房（PICU）入院时测量血清白蛋白和乳酸，同时进行舌下视频显微镜检查以测量微循环。

A total of 178 children were included, 37% of whom had septic shock measured with the Phoenix Sepsis Score. Patients with remote sepsis had greater odds of an elevated LAR (aOR 6.87: 95% CI 1.98–23.73; p < 0.01). Children with an elevated LAR had more microvascular blood flow abnormalities (aOR 1.31 95% CI 1.08–1.58; p < 0.01), lower 4-6-micron capillary density (aOR 1.03 95% CI 1.01–1.05; p < 0.01) and greater odds of dying (aOR 3.55 95% CI 1.21–10.38; p = 0.02) compared to those with a low LAR.

共纳入178名儿童，其中37%患有凤凰城脓毒症评分测量的脓毒性休克。远端脓毒症患者LAR升高的几率更高（aOR 6.87:95%CI 1.98-23.73；p<0.01）。与LAR较低的儿童相比，LAR升高的儿童有更多的微血管血流异常（aOR 1.31 95%CI 1.08-1.58；p<0.01），较低的4-6微米毛细血管密度（aOR 1.03 95%CI 1.01-1.05；p<0.01）和更高的死亡几率（aOR 3.55 95%CI 1.21-10.38；p=0.02）。

We found no association between LAR and endothelial glycocalyx degradation. A normal LAR is associated with less risk of microcirculatory injury (aOR 0.77 95% CI 0.65–0.93; p < 0.01). In children with sepsis, an elevated LAR is associated with microcirculation abnormalities (microvascular density and flow).

我们发现LAR与内皮糖萼降解之间没有关联。正常的LAR与微循环损伤的风险较低相关（aOR 0.77 95%CI 0.65-0.93；p<0.01）。在脓毒症儿童中，LAR升高与微循环异常（微血管密度和流量）有关。

The lactate/albumin ratio is a potentially useful biomarker for microcirculatory injury in sepsis..

乳酸/白蛋白比率是脓毒症微循环损伤的潜在有用生物标志物。。

IntroductionSepsis is a severe critical condition caused by infection leading to organ dysfunction, with cardiovascular problems being the main cause of death in the first 48 h after diagnosis1,2,3,4. Traditionally, hemodynamic status has been assessed using macrocirculation outcome variables (e.g., blood pressure, heart rate, pulse pressure, cardiac output, etc.) which have been taken as surrogates for tissue perfusion3.

引言脓毒症是由感染引起的严重危重病，导致器官功能障碍，心血管问题是诊断后48小时内死亡的主要原因1,2,3,4。。

In this regard, serum lactate is a biomarker for tissue hypoxia that indicates abnormal perfusion and is used in adults and children as a marker of severity and a guide for interventions5,6. However, lactate levels may be elevated in circumstances unrelated to tissue hypoxia7. On the other hand, serum albumin is both a nutritional biomarker and an acute phase reactant in inflammatory states.

在这方面，血清乳酸是组织缺氧的生物标志物，表明灌注异常，并在成人和儿童中用作严重程度的标志物和干预指南5,6。然而，在与组织缺氧无关的情况下，乳酸水平可能会升高7。另一方面，血清白蛋白既是营养生物标志物，也是炎症状态下的急性期反应物。

Hypoalbuminemia is associated with higher mortality and worse outcomes in patients with sepsis8,9. Low albumin levels may occur in children with sepsis due to increased microvascular permeability (associated with systemic inflammation), increased capillary leak syndrome and decreased hepatic synthesis10,11.In children with sepsis vascular endothelial dysfunction occurs as a result of inflammation and tissue hypoxia11.

低白蛋白血症与脓毒症患者的死亡率较高和预后较差有关8,9。由于微血管通透性增加（与全身炎症相关），毛细血管渗漏综合征增加和肝合成减少，脓毒症儿童可能会出现低白蛋白水平10,11。脓毒症儿童血管内皮功能障碍是炎症和组织缺氧的结果11。

This situation contributes to multiple organ dysfunction syndrome (MODS) secondary to sepsis, and mortality12,13. The serum levels of lactate and albumin in these cases have been evaluated separately and associated with worse outcomes. Wang B et al.14 evaluated these two biomarkers jointly in adults with sepsis.

这种情况导致继发于败血症的多器官功能障碍综合征（MODS）和死亡率12,13。这些病例的血清乳酸和白蛋白水平已分别评估，并与较差的结果相关。Wang B等[14]在脓毒症成人中联合评估了这两种生物标志物。

This ratio was termed the “lactate-albumin ratio (LAR).” They found that, in adults with sepsis, a high LAR was associated with higher mortality and MODS14. Since then, this ratio has been used as a prognostic biomarker in critically ill patie.

这个比率被称为“乳酸白蛋白比率（LAR）”。他们发现，在脓毒症患者中，高LAR与较高的死亡率和MODS14相关。从那时起，这个比例已被用作危重病人的预后生物标志物。

Data availability

数据可用性

The datasets used and/or analysed during the current study available from the corresponding author on reasonable request.

本研究中使用和/或分析的数据集可根据合理要求从通讯作者处获得。

ReferencesSchlapbach, L. J. et al. International consensus criteria for pediatric sepsis and septic shock. JAMA331(8), 665–674 (2024).Article

参考Chlapbach，L.J.等人，《小儿败血症和感染性休克的国际共识标准》。JAMA331（8），665-674（2024）。文章

PubMed

PubMed Central

公共医学中心

Google Scholar

谷歌学者

Sanchez-Pinto, L. N. et al. Development and validation of the phoenix criteria for pediatric sepsis and septic shock. JAMA331(8), 675–686 (2024).Article

桑切斯·平托（Sanchez Pinto，L.N.）等人，《凤凰城小儿败血症和感染性休克标准的制定和验证》。JAMA331（8），675-686（2024）。文章

PubMed

PubMed Central

公共医学中心

Google Scholar

谷歌学者

Weiss, S. L. et al. Surviving sepsis campaign international guidelines for the management of septic shock and sepsis-associated organ dysfunction in children. Pediatr. Crit. Care Med.21(2), e52–e106 (2020).Article

Weiss，S.L.等人，《存活败血症运动国际儿童感染性休克和败血症相关器官功能障碍管理指南》。儿科。暴击。护理医学21（2），e52-e106（2020）。文章

PubMed

Google Scholar

谷歌学者

Souza, D. C. et al. Epidemiology of sepsis in children admitted to PICUs in South America. Pediatr. Crit. Care Med.17(8), 727–734 (2016).Article

Souza，D.C.等人。南美PICU入院儿童败血症的流行病学。儿科。暴击。护理医学17（8），727-734（2016）。文章

PubMed

Google Scholar

谷歌学者

Scott, H. F. et al. Association between early lactate levels and 30-Day mortality in clinically suspected sepsis in children. JAMA Pediatr.171(3), 249–255 (2017).Article

Scott，H.F.等人。临床疑似脓毒症儿童早期乳酸水平与30天死亡率之间的关系。JAMA儿科杂志171（3），249-255（2017）。文章

PubMed

Google Scholar

谷歌学者

Hernández, G. et al. Effect of a resuscitation strategy targeting peripheral perfusion status vs serum lactate levels on 28-Day mortality among patients with septic shock: the ANDROMEDA-SHOCK randomized clinical trial. JAMA321(7), 654–664 (2019).Article

Hernández，G.等人。针对外周灌注状态与血清乳酸水平的复苏策略对感染性休克患者28天死亡率的影响：ANDROMEDA-shock随机临床试验。JAMA321（7），654-664（2019）。文章

PubMed

PubMed Central

公共医学中心

Google Scholar

谷歌学者

Rabinowitz, J. D. et al. Lactate: The ugly duckling of energy metabolism. Nat. Metab.2(7), 566–571 (2020).Article

Rabinowitz，J.D.等人，《乳酸：能量代谢的丑小鸭》。《自然代谢》2（7），566-571（2020）。文章

CAS

中科院

PubMed

PubMed Central

公共医学中心

Google Scholar

谷歌学者

Qiu, W. et al. Interpretable machine learning prediction of all-cause mortality. Commun. Med. (Lond). 3 (2), 125 (2022).Article

邱，W。等。全因死亡率的可解释机器学习预测。Commun公司。。3（2），125（2022）。文章

ADS

Google Scholar

谷歌学者

Saucedo-Moreno, E. M. et al. Hypoalbuminemia as a predictor of mortality in abdominal sepsis. Cir. Cir.88 (4), 481–484 (2020).PubMed

Saucedo Moreno，E.M.等人。低白蛋白血症作为腹部败血症死亡率的预测指标。Cir.Cir.88（4），481–484（2020）。PubMed出版社

Google Scholar

谷歌学者

Sanchez-Pinto, L. N. et al. Derivation, validation, and clinical relevance of a pediatric sepsis phenotype with persistent hypoxemia, encephalopathy, and shock. Pediatr. Crit. Care Med.24(10), 795–806 (2023).Article

Sanchez-Pinto，L.N.等人。小儿败血症表型与持续性低氧血症、脑病和休克的推导、验证和临床相关性。儿科。暴击。护理医学24（10），795-806（2023）。文章

PubMed

PubMed Central

公共医学中心

Google Scholar

谷歌学者

Fernández-Sarmiento, J. et al. The association between hypoalbuminemia and microcirculation, endothelium, and glycocalyx disorders in children with sepsis. Microcirculation30(8), 1–10 (2023).Article

Fernández-Sarmiento，J.等人。脓毒症儿童低白蛋白血症与微循环，内皮和糖萼疾病之间的关系。微循环30（8），1-10（2023）。文章

Google Scholar

谷歌学者

Shen, Y. et al. Meta-analysis for the prediction of mortality rates in a pediatric intensive care unit using different scores: PRISM-III/IV, PIM-2, and PELOD-2. Front. Pediatr.24, 712276 (2021).Article

Shen，Y。等人。使用不同评分预测儿科重症监护病房死亡率的荟萃分析：PRISM-III/IV，PIM-2和PELOD-2。正面。儿科24712276（2021）。文章

Google Scholar

谷歌学者

Sarta-Mantilla, M. et al. Microcirculation, endothelium and glycocalyx changes associated with the use of milrinone in children with septic shock. Transl. Pediatr.31(5), 727–737 (2024).Article

。翻译。儿科31（5），727-737（2024）。文章

Google Scholar

谷歌学者

Wang, B. et al. Correlation of lactate/albumin ratio level to organ failure and mortality in severe sepsis and septic shock. J. Crit. Care. 30, 271–275 (2015).Article

Wang，B.等人。严重脓毒症和感染性休克中乳酸/白蛋白比值水平与器官衰竭和死亡率的相关性。J、致命护理。30271-275（2015）。文章

CAS

中科院

PubMed

Google Scholar

谷歌学者

Gharipour, A. et al. Lactate/albumin ratio: An early prognostic marker in critically ill patients. Am. J. Emerg. Med.38(10), 2088–2095 (2020).Article

Gharipour，A。等。乳酸/白蛋白比率：危重患者的早期预后标志物。《美国急诊医学杂志》38（10），2088–2095（2020）。文章

PubMed

Google Scholar

谷歌学者

Bou Chebl, R. et al. Lactate/albumin ratio as a predictor of In-Hospital mortality in septic patients presenting to the emergency department. Front. Med. (Lausanne)22(7), 550182 (2020).Article

Bou Chebl，R。等人。乳酸/白蛋白比率作为急诊科脓毒症患者住院死亡率的预测指标。正面。医学（洛桑）22（7），550182（2020）。文章

Google Scholar

谷歌学者

Ray, C. C. The association of the lactate-albumin ratio with mortality and multiple organ dysfunction in PICU patients. Pediatr. Crit. Care Med.24(9), 760–766 (2023).Article

Ray，C.C。PICU患者乳酸白蛋白比率与死亡率和多器官功能障碍的关系。儿科。暴击。护理医学24（9），760-766（2023）。文章

PubMed

PubMed Central

公共医学中心

Google Scholar

谷歌学者

Perizes, E. N. et al. Derivation and validation of vasoactive Inotrope score trajectory groups in critically Ill children with shock. Pediatr. Crit. Care Med.23(12), 1017–1026 (2022).Article

Perizes，E.N.等人。危重症休克儿童血管活性肌力评分轨迹组的推导和验证。儿科。暴击。护理医学杂志23（12），1017-1026（2022）。文章

PubMed

PubMed Central

公共医学中心

Google Scholar

谷歌学者

Smadja, D. M. et al. Angiopoietin-2 as a marker of endothelial activation is a good predictor factor for intensive care unit admission of COVID-19 patients. Angiogenesis. 23 (4), 611–620 (2020).Article

Smadja，D.M.等人。血管生成素-2作为内皮激活的标志物是新型冠状病毒肺炎患者入住重症监护病房的良好预测因素。血管生成。23（4），611-620（2020）。文章

CAS

中科院

PubMed

PubMed Central

公共医学中心

Google Scholar

谷歌学者

Ince, C. et al. Cardiovascular dynamics section of the ESICM. Second consensus on the assessment of sublingual microcirculation in critically ill patients: Results from a task force of the European Society of Intensive Care Medicine. Intensive Care Med.44(3), 281–299 (2018).Article

Ince，C。等人。ESICM的心血管动力学部分。。重症监护医学44（3），281-299（2018）。文章

PubMed

Google Scholar

谷歌学者

Rovas, A. et al. Identification of novel sublingual parameters to analyze and diagnose microvascular dysfunction in sepsis: The NOSTRADAMUS study. Crit. Care25, 112 (2021).Article

Rovas，A.等人。识别新的舌下参数以分析和诊断败血症中的微血管功能障碍：NOSTRADAMUS研究。暴击。。文章

PubMed

PubMed Central

公共医学中心

Google Scholar

谷歌学者

Nussbaum, C. et al. Perturbation of the microvascular glycocalyx and perfusion in infants after cardiopulmonary bypass. J. Thorac. Cardiovasc. Surg.150, 1474–1481 (2015).Article

Nussbaum，C。等人。体外循环后婴儿微血管糖萼和灌注的扰动。J、胸部。心血管。Surg.1501474-1481（2015）。文章

PubMed

Google Scholar

谷歌学者

Fernández-Sarmiento, J. et al. Endothelial and glycocalyx biomarkers in children with sepsis after one Bolus of unbalanced or balanced crystalloids. Pediatr. Crit. Care Med.24(3), 213–221 (2023).Article

Fernández Sarmiento，J.等人。一次不平衡或平衡晶体推注后脓毒症儿童的内皮和糖萼生物标志物。儿科。暴击。护理医学24（3），213-221（2023）。文章

PubMed

Google Scholar

谷歌学者

Fernández-Sarmiento, J. et al. The association between prolonged capillary refill time and microcirculation changes in children with sepsis. BMC Pediatr.24 (1), 68 (2024).Article

Fernández Sarmiento，J.等人。脓毒症儿童毛细血管再充盈时间延长与微循环改变之间的关系。BMC Pediatr.24（1），68（2024）。文章

PubMed

PubMed Central

公共医学中心

Google Scholar

谷歌学者

Rovas, A. et al. Bedside analysis of the sublingual microvascular glycocalyx in the emergency room and intensive care unit - the GlycoNurse study. Scand. J. Trauma. Resusc. Emerg. Med.26 (1), 16 (2018).Article

Rovas，A。等人。急诊室和重症监护室舌下微血管糖萼的床边分析-GlycoNurse研究。斯堪的纳维亚。J、创伤。结果。Emerg.Med.26（1），16（2018）。文章

PubMed

PubMed Central

公共医学中心

Google Scholar

谷歌学者

Rovas, A. et al. Microvascular and proteomic signatures overlap in COVID-19 and bacterial sepsis: The MICROCODE study. Angiogenesis25(4), 503–515 (2022).Article

。血管生成25（4），503-515（2022）。文章

CAS

中科院

PubMed

PubMed Central

公共医学中心

Google Scholar

谷歌学者

Guo, W. et al. The value of lactate/albumin ratio for predicting the clinical outcomes of critically ill patients with heart failure. Ann. Transl. Med.9, 118 (2021).Article

郭，W。等。乳酸/白蛋白比值预测重症心力衰竭患者临床结局的价值。安。翻译。医学杂志9118（2021）。文章

CAS

中科院

PubMed

PubMed Central

公共医学中心

Google Scholar

谷歌学者

Lu, Y. et al. Association between lactate/albumin ratio and all-cause mortality in patients with acute respiratory failure: A retrospective analysis. PLoS One16, e0255744 (2021).Article

Lu，Y.等。急性呼吸衰竭患者乳酸/白蛋白比值与全因死亡率的关系：回顾性分析。PLoS One16，e025744（2021）。文章

ADS

CAS

中科院

PubMed

PubMed Central

公共医学中心

Google Scholar

谷歌学者

Wang, R. et al. Lactate albumin ratio is associated with mortality in patients with moderate to severe traumatic brain Injury. Front. Neurol.1(13), 662385 (2022).Article

Wang，R。等人。乳酸-白蛋白比率与中重度创伤性脑损伤患者的死亡率相关。正面。神经学1（13），662385（2022）。文章

Google Scholar

谷歌学者

Dudoignon, E. et al. Usefulness of lactate albumin ratio at admission to predict 28-day mortality in critically ill severely burned patients: A retrospective cohort study. Burns48, 1836–1844 (2022).Article

Dudoignon，E.等人。入院时乳酸-白蛋白比率预测重症严重烧伤患者28天死亡率的有用性：一项回顾性队列研究。伯恩斯481836-1844（2022）。文章

PubMed

Google Scholar

谷歌学者

Lau, K. K. et al. Utility of the Lactate/Albumin ratio as a predictor for mortality in necrotizing Fasciitis patients. Emerg. Med. Int.13, 3530298 (2021).

。急诊医学Int.133530298（2021）。

Google Scholar

谷歌学者

Wang, G. et al. Lactate/albumin ratio as a predictor of in-hospital mortality in critically ill children. BMC Pediatr.22 (1), 725 (2022).Article

Wang，G。等人。乳酸/白蛋白比率作为危重患儿住院死亡率的预测指标。BMC Pediatr.22（1），725（2022）。文章

CAS

中科院

PubMed

PubMed Central

公共医学中心

Google Scholar

谷歌学者

Wang, D. et al. Association between lactate/albumin ratio and all-cause mortality in critical patients with acute myocardial infarction. Sci. Rep.13 (1), 15561 (2023).Article

Wang，D.等。急性心肌梗死危重患者乳酸/白蛋白比值与全因死亡率的关系。科学。代表13（1），15561（2023）。文章

ADS

MathSciNet

CAS

中科院

PubMed

PubMed Central

公共医学中心

Google Scholar

谷歌学者

De Santis, P. et al. Incoherence between systemic hemodynamic and microcirculatory response to fluid challenge in critically ill patients. J. Clin. Med.10(3), 507 (2021).Article

De Santis，P。等人。危重患者全身血液动力学和微循环对液体挑战的反应不一致。J、临床。医学杂志10（3），507（2021）。文章

PubMed

PubMed Central

公共医学中心

Google Scholar

谷歌学者

Mallat, J. et al. Pathophysiology, mechanisms, and managements of tissue hypoxia. Anaesth. Crit. Care Pain Med.41 (4), 101087 (2022).Article

Mallat，J。等人。组织缺氧的病理生理学，机制和管理。Anaesth公司。暴击。Care Pain Med.41（4），101087（2022）。文章

PubMed

Google Scholar

谷歌学者

Duranteau, J. et al. The future of intensive care: The study of the microcirculation will help to guide our therapies. Crit. Care27(1), 190 (2023).Article

Duranteau，J.等人，《重症监护的未来：微循环的研究将有助于指导我们的治疗。暴击。护理27（1），190（2023）。文章

CAS

中科院

PubMed

PubMed Central

公共医学中心

Google Scholar

谷歌学者

Hernandez, G. et al. Monitoring capillary refill time in septic shock. Intensive Care Med.50 (4), 580–582 (2024).Horvat, C. Statistical note: Confounding and causality in observational studies. Pediatr. Crit. Care Med.22(5), 496–498 (2021).Article

Hernandez，G。等人。监测感染性休克的毛细血管再充盈时间。重症监护医学50（4），580-582（2024）。Horvat，C。统计说明：观察性研究中的混淆和因果关系。儿科。暴击。护理医学杂志22（5），496-498（2021）。文章

PubMed

PubMed Central

公共医学中心

Google Scholar

谷歌学者

Dahabreh, I. J. & Bibbins-Domingo, K. Causal inference about the effects of interventions from observational studies in medical journals. JAMA May9, https://doi.org/10.1001/jama.2024.7741 (2024).Download referencesAcknowledgementsI would like to thank the PICU physicians and nurses at Fundación Cardioinfantil for their constant help with our patients.Funding This study was supported by the MED256-2019 project at Universidad de La Sabana.Author informationAuthors and AffiliationsDepartment of Critical Care Medicine and Pediatrics, Fundación Cardioinfantil- Instituto de Cardiología, Universidad de La Sabana, Campus Universitario del Puente del Común, Km 7 Autopista Norte de Bogotá, Chía – Cundinamarca, Bogotá, ColombiaMaria Camila Pérez, Jaime Fernández-Sarmiento, Juan David Bustos, Sarah Ferro-Jackaman, Paula Ramírez-Caicedo, Natalia Lucena, José Manuel Fernández-Rengifo, Lorena Acevedo, Juan David Suárez & Catalina Duque-ArangoDepartment of Emergency Medicine and Pediatrics, Fundación Cardioinfantil-Instituto de Cardiología, Bogotá, ColombiaAndrés Nieto, Sofia Barrera, Carolina Cárdenas & Maria Camila GaravitoDepartment of Critical Care Medicine and Pediatrics, Fundación Cardioinfantil- Instituto de Cardiología, Universidad del Rosario , Bogotá, ColombiaJuan Pablo Fernández-Sarta, Isabella La Rotta, Alejandro Coutin & Juanita PatiñoAuthorsMaria Camila PérezView author publicationsYou can also search for this author in.

Dahabreh，I.J.&Bibbins-Domingo，K.。医学期刊观察研究干预效果的因果推断。Jama May9，https://doi.org/10.1001/jama.2024.7741（2024年）。下载ReferenceSackNowledgementsi要感谢儿童心脏基金会的PICU医生和护士不断帮助我们的患者。这项研究的资金得到了萨瓦纳大学MED256-2019项目的支持。作者信息作者和附属机构重症监护医学和儿科部，心脏病学基金会-心脏病学研究所，萨瓦纳大学，普恩特·德尔·科穆诺大学校园，波哥大北部高速公路7公里，恰-昆迪纳马卡，波哥大，哥伦比亚人卡米拉·佩雷斯，海梅·费尔南德斯·萨米恩托，胡安·大卫·布斯塔斯，萨拉·费罗·杰卡曼，宝拉·拉米雷斯·凯塞多，娜塔莉亚·卢塞纳，何塞·曼努埃尔·费尔南德斯·伦吉福，洛雷娜·阿塞维多，胡安·大卫·苏亚雷斯和凯瑟琳·杜克-紧急医学和儿科部门，儿童心脏基金会-心脏病研究所，波哥大，哥伦比亚安德烈斯·涅托，索菲亚·巴雷拉，卡罗琳娜·卡德纳斯和玛丽亚·卡米拉·加拉维托德重症监护医学和儿科部门，儿童心脏基金会-心脏病学研究所，罗萨里奥大学，波哥大，哥伦比亚胡安·巴勃罗·费尔南德斯-萨塔，伊莎贝拉·拉罗塔，Alejandro Coutin和Juanita PatinioAuthorsMaria Camila Perezview Author Publicationsyou也可以在中搜索这位作者。

PubMed Google ScholarJaime Fernández-SarmientoView author publicationsYou can also search for this author in

PubMed Google ScholarJaime Fernández SarmientoView作者出版物您也可以在

PubMed Google ScholarJuan David BustosView author publicationsYou can also search for this author in

PubMed谷歌学者Juan David BustosView作者出版物您也可以在

PubMed Google ScholarSarah Ferro-JackamanView author publicationsYou can also search for this author in

PubMed Google ScholarSarah Ferro JackamanView作者出版物您也可以在

PubMed Google ScholarPaula Ramírez-CaicedoView author publicationsYou can also search for this author in

PubMed Google ScholarPaula Ramírez CaicedoView作者出版物您也可以在

PubMed Google ScholarAndrés NietoView author publicationsYou can also search for this author in

PubMed Google ScholarAndrés NietoView作者出版物您也可以在

PubMed Google ScholarNatalia LucenaView author publicationsYou can also search for this author in

PubMed Google ScholarNatalia LucenaView作者出版物您也可以在

PubMed Google ScholarSofia BarreraView author publicationsYou can also search for this author in

PubMed Google ScholarSofia BarreraView作者出版物您也可以在

PubMed Google ScholarJosé Manuel Fernández-RengifoView author publicationsYou can also search for this author in

PubMed Google ScholarJoséManuel Fernández RengifoView作者出版物您也可以在

PubMed Google ScholarCarolina CárdenasView author publicationsYou can also search for this author in

PubMed Google ScholarCarolina CárdenasView作者出版物您也可以在

PubMed Google ScholarMaria Camila GaravitoView author publicationsYou can also search for this author in

PubMed Google ScholarMaria Camila GaravitoView作者出版物您也可以在

PubMed Google ScholarJuan Pablo Fernández-SartaView author publicationsYou can also search for this author in

PubMed谷歌学者胡安·巴勃罗·费尔南德斯·萨塔维（JuanPabloFernándezSartaview）作者出版物您也可以在

PubMed Google ScholarIsabella La RottaView author publicationsYou can also search for this author in

PubMed Google ScholarAlejandro CoutinView author publicationsYou can also search for this author in

PubMed Google ScholarAlejandro CoutinView作者出版物您也可以在

PubMed Google ScholarJuanita PatiñoView author publicationsYou can also search for this author in

PubMed Google ScholarJuanita PatiñoView作者出版物您也可以在

PubMed Google ScholarLorena AcevedoView author publicationsYou can also search for this author in

PubMed Google ScholarLorena AcevedoView作者出版物您也可以在

PubMed Google ScholarJuan David SuárezView author publicationsYou can also search for this author in

PubMed谷歌学者胡安·戴维·苏亚雷斯·维尤（JuanDavidSuárezView）作者出版物您也可以在

PubMed Google ScholarCatalina Duque-ArangoView author publicationsYou can also search for this author in

PubMed Google ScholarCatalina Duque ArangoView作者出版物您也可以在

PubMed Google ScholarContributionsMCP, JFS contributed to the concept or design of the study, data collection, analysis or interpretation of the data, drafting of the manuscript, and critical review of the manuscript for important intellectual content. All authors (MCP, JFS, JDB, SFJ, PRC, AN, NL, SF, JMF, CC, MAG, JPFS, ILR, AC, JP, LA, JDS, CDA) had full access to the data, contributed to the data collection, approved the final version for publication, and take responsibility for its accuracy and integrity.Corresponding authorCorrespondence to.

PubMed Google ScholarContributionsMCP，JFS为研究的概念或设计，数据收集，数据分析或解释，稿件起草以及重要知识内容稿件的批判性审查做出了贡献。所有作者（MCP，JFS，JDB，SFJ，PRC，AN，NL，SF，JMF，CC，MAG，JPFS，ILR，AC，JP，LA，JDS，CDA）都可以完全访问数据，为数据收集做出了贡献，批准了最终版本的发布，并对其准确性和完整性负责。对应作者对应。

Jaime Fernández-Sarmiento.Ethics declarations

海梅·费尔南德斯·萨米恩托。道德宣言

Competing interests

相互竞争的利益

The authors declare no competing interests.

作者声明没有利益冲突。

Additional informationPublisher’s noteSpringer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.Electronic supplementary materialBelow is the link to the electronic supplementary material.Supplementary Material 1Rights and permissions

Additional informationPublisher的noteSpringer Nature在已发布地图和机构隶属关系中的管辖权主张方面保持中立。电子补充材料流是指向电子补充材料的链接。补充材料1权利和许可

Open Access This article is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License, which permits any non-commercial use, sharing, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if you modified the licensed material.

开放获取本文是根据知识共享署名非商业性NoDerivatives 4.0国际许可证授权的，该许可证允许以任何媒介或格式进行任何非商业性使用，共享，分发和复制，只要您对原始作者和来源给予适当的信任，提供知识共享许可证的链接，并指出您是否修改了许可材料。

You do not have permission under this licence to share adapted material derived from this article or parts of it. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder.

To view a copy of this licence, visit http://creativecommons.org/licenses/by-nc-nd/4.0/..

要查看此许可证的副本，请访问http://creativecommons.org/licenses/by-nc-nd/4.0/..

Reprints and permissionsAbout this articleCite this articlePérez, M.C., Fernández-Sarmiento, J., Bustos, J.D. et al. Association between the lactate-albumin ratio and microcirculation changes in Pediatric Septic patients.

转载和许可本文引用本文Pérez，M.C.，Fernández-Sarmiento，J.，Bustos，J.D。等人。小儿脓毒症患者乳酸白蛋白比率与微循环变化之间的关联。

Sci Rep 14, 22579 (2024). https://doi.org/10.1038/s41598-024-73112-5Download citationReceived: 21 May 2024Accepted: 13 September 2024Published: 29 September 2024DOI: https://doi.org/10.1038/s41598-024-73112-5Share this articleAnyone you share the following link with will be able to read this content:Get shareable linkSorry, a shareable link is not currently available for this article.Copy to clipboard.

Sci Rep 1422579（2024）。https://doi.org/10.1038/s41598-024-73112-5Download引文收到日期：2024年5月21日接受日期：2024年9月13日发布日期：2024年9月29日OI：https://doi.org/10.1038/s41598-024-73112-5Share本文与您共享以下链接的任何人都可以阅读此内容：获取可共享链接对不起，本文目前没有可共享的链接。复制到剪贴板。

Provided by the Springer Nature SharedIt content-sharing initiative

由Springer Nature SharedIt内容共享计划提供

KeywordsChildrenSepsisMortalitySeptic shockFluid bolus

关键词Schildrensepsismortalityseptic shockFluid推注

CommentsBy submitting a comment you agree to abide by our Terms and Community Guidelines. If you find something abusive or that does not comply with our terms or guidelines please flag it as inappropriate.

评论通过提交评论，您同意遵守我们的条款和社区指南。如果您发现有虐待行为或不符合我们的条款或准则，请将其标记为不合适。

全球产业链接平台

重庆市渝北区金星科技大厦A区5楼512室

联系电话：023-67139735（重庆）

关于我们

产品服务