Base deficit, lactate clearance, and shock index as predictors of morbidity and mortality in multiple-trauma patients

  • Carlos Andrés Cortés-Samacá Medical School, Universidad Industrial de Santander (UIS), Bucaramanga, Colombia
  • Héctor Julio Meléndez-Flórez Medical School, Universidad Industrial de Santander (UIS), Bucaramanga, Colombia
  • Saúl Álvarez Robles Medical School, Universidad Industrial de Santander (UIS), Bucaramanga, Colombia
  • Eduardo Andrés Meléndez-Gómez Intensive Care Unit, Clínica Carlos Ardila Lulle, Floridablanca, Colombia
  • Carla Andrea Puche-Cogollo Post-Anesthesia Care Unit, Hospital Universitario de Santander (HUS), Bucaramanga, Colombia.
  • Henry Jair Mayorga-Anaya Medical School, Universidad Industrial de Santander (UIS), Bucaramanga, Colombia
Keywords: Lactic Acid, Morbidity, Mortality, Multiple Trauma, Hemorrhage

Abstract

Introduction:

Physiological responses to hemorrhage are not proportional to blood loss. This has led to the use of scores such as the shock index (SI) or biomarkers such as lactate clearance (LC) and base deficit (BD) in the assessment of multiple trauma patients.

Objective:

To determine the risk between no LC, persistence of BD, and severe SI at 6 hours, and postoperative morbidity and mortality.

Methods:

Prospective cohort study with multiple trauma patients taken to surgery. SI, BD, and lactate levels were calculated on admission and after 6hours; LC was estimated at 6 hours; and follow-up was performed after 28 days to determine morbidity and mortality. Inadequate LC was defined as <20% at 6hours, severe SI as >1, and abnormal BD as <-6 mmol/L.

Results:

Overall, 196 patients were assessed. Morbidity and mortality were 46.24% and 19.69%, respectively. Relative risks for morbidity such as surgical reintervention, acute renal injury (ARI), pneumonia, need for vasopressors, and transfusions were significant for LC < 20%. Severe SI and BD on admission were not found to be significant predictors, but after 6 hours, their behavior was similar to that of LC. In the final model, the significant variables for mortality were LC < 20% at 6 hours, ARI, age >45 years, suture dehiscence, transfusions.

Conclusion:

In multiple trauma patients in shock, low LC, severe SI, and persistent BD at 6 hours were significant for morbidity and mortality and their use as follow-up markers should be encouraged in resuscitation therapies for patients in shock.

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How to Cite
1.
Cortés-Samacá CA, Meléndez-Flórez HJ, Álvarez Robles S, Meléndez-Gómez EA, Puche-Cogollo CA, Mayorga-Anaya HJ. Base deficit, lactate clearance, and shock index as predictors of morbidity and mortality in multiple-trauma patients. Colomb. J. Anesthesiol. [Internet]. 2018 Jul. 1 [cited 2024 Feb. 23];46(3):209-17. Available from: https://www.revcolanest.com.co/index.php/rca/article/view/520

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Published
2018-07-01
How to Cite
1.
Cortés-Samacá CA, Meléndez-Flórez HJ, Álvarez Robles S, Meléndez-Gómez EA, Puche-Cogollo CA, Mayorga-Anaya HJ. Base deficit, lactate clearance, and shock index as predictors of morbidity and mortality in multiple-trauma patients. Colomb. J. Anesthesiol. [Internet]. 2018 Jul. 1 [cited 2024 Feb. 23];46(3):209-17. Available from: https://www.revcolanest.com.co/index.php/rca/article/view/520
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