Lactate clearance: prognostic mortality marker in trauma patients
Abstract
Introduction:
High lactate values are associated with adverse outcomes in almost all clinical situations, lactate levels above 2 mmol/L are proposed as an early and reliable marker of tissue hypoperfusion, and lactate clearance during treatment has also been proposed during resuscitation as a prognostic factor.
Objective:
To determine the association between the initial value of lactate and its clearance after 6 and 24 hours in trauma patients with mortality.
Materials and methods:
A subanalysis of a prospective cohort collected between March 2014 and October 2016 was carried out at the San Vicente Fundación University Hospital (Medellin, Colombia), with trauma patients over 18 years of age. Lactate and clinical variables were measured at admission, at 6 and at 24hours. The association of lactate levels at admission and clearance with in hospital mortality was estimated, using logistic regression models.
Results:
A total of 251 patients met the inclusion criteria, 15.5% died, 45.4% required admission to intensive care, in patients who died the lactate at admission was 4.6mmol/L (Interquartile range = 2.9-6.9). The adjusted logistic regression model showed that lactate on admission, lactate clearance of 50% (0-24hours), trauma mechanism, and Sequential Organ Failure Assessment score were independent factors associated with mortality.
Conclusion:
High values of lactate at admission are associated with greater probability of dying and its clearance is an independent factor of mortality in those who enter with high lactate values.
References
2. Vincent JL, Quintairos ESA, Couto L, et al. The value of blood lactate kinetics in critically ill patients: a systematic review. Crit Care 2016;20:257.
3. Manikis P, Jankowski S, Zhang H, et al. Correlation of serial blood lactate levels to organ failure and mortality after trauma. Am J Emerg Med 1995;13:619-622.
4. Aluisio AR, Jain A, Baron BJ, et al. The prognostic role of non-critical lactate levels for in-hospital survival time among ED patients with sepsis. Am J Emerg Med 2016;34:170-173.
5. Abramson D, Scalea TM, Hitchcock R, et al. Lactate clearance and survival following injury. J Trauma 1993;35:584-588. discussion 8-9.
6. Regnier MA, Raux M, Le Manach Y, et al. Prognostic significance of blood lactate and lactate clearance in trauma patients. Anesthesiology 2012;117:1276-1288.
7. Odom SR, Howell MD, Silva GS, et al. Lactate clearance as a predictor of mortality in trauma patients. J Trauma Acute Care Surg 2013;74:999-1004.
8. Charlson ME, Pompei P, Ales KL, et al. A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis 1987;40:373-383.
9. Knaus WA, Draper EA, Wagner DP, et al. APACHE II: a severity of disease classification system. Crit Care Med 1985;13:818-829.
10. Champion HR, Sacco WJ, Copes WS, et al. A revision of the trauma score. J Trauma 1989;29:623-629.
11. Cecconi M, De Backer D, Antonelli M, et al. Consensus on circulatory shock and hemodynamic monitoring. Task force of the European Society of Intensive Care Medicine. Intensive Care Med 2014;40:1795-1815.
12. Londoño J, Niño C, Díaz J, et al. Association of cllinical variables of hypoperfusion with lactate and mortality. Acta Médica Colombiana 2017;42:97-105.
13. Cortés-Samacá CA, Meléndez-Flórez HJ, Robles SÁ, et al. Base deficit, lactate clearance, and shock index as predictors of morbidity and mortality in multiple-trauma patients. Rev Colomb Anestesiol 2018;46:208-215.
14. Brown JB, Lerner EB, Sperry JL, et al. Prehospital lactate improves accuracy of prehospital criteria for designating trauma activation level. J Trauma Acute Care Surg 2016;81:445-452.
15. Dunne JR, Tracy JK, Scalea TM, et al. Lactate and base deficit in trauma: does alcohol or drug use impair their predictive accuracy? J Trauma 2005;58:959-966.
16. Ouellet JF, Roberts DJ, Tiruta C, et al. Admission base deficit and lactate levels in Canadian patients with blunt trauma: are they useful markers of mortality? J Trauma Acute Care Surg 2012;72:1532-1535.
17. Baxter J, Cranfield KR, Clark G, et al. Do lactate levels in the emergency department predict outcome in adult trauma patients? A systematic review. J Trauma Acute Care Surg 2016;81:555-566.
18. Oliveros-Rodríguez H, Estupiñán-López R, Rodríguez-Gómez J. Lactate serial measurements and predictive validity of early mortality in trauma patients admitted to the intensive care unit. Rev Colomb Anestesiol 2017;45:166-172.
19. González M, Morales C, Sanabria A. Lactate clearance: prognostic marker of mortality in trauma patients Systematic Review. Rev Colomb Cir 2016;31:34-43.
Downloads
Altmetric
| Article metrics | |
|---|---|
| Abstract views | |
| Galley vies | |
| PDF Views | |
| HTML views | |
| Other views | |
