Base deficit, lactate clearance, and shock index as predictors of morbidity and mortality in multiple-trauma patients
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.
References
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13. Kruse O, Grunnet N, Barfod C. Blood lactate as a predictor for inhospital mortality in patients admitted acutely to hospital: a systematic review. Scand J Trauma Resusc Emerg Med 2011;19:74.
14. 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.
15. González M, Morales CH, Sanabria Á. Lactate clearance as a prognostic factor in patients with penetrating trauma. Rev Colomb Cir 2016;31:34-43.
16. 0Baxter 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.
17. 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.
18. Dekker SE, de Vries HM, Lubbers WD, et al. Lactate clearance metrics are not superior to initial lactate in predicting mortalityin trauma. Eur J Trauma Emerg Surg 2016;42:1-11.
19. Ibrahim I, Chor WP, Chue KM, et al. Is arterial base deficit still a useful prognostic marker in trauma? A systematic review. Am J Emerg Med 2016;34:626-635.
20. Mitra B, Fitzgerald M, Chan J. The utility of a shock index >1asan indication for pre-hospital oxygen carrier administration in major trauma. Injury 2014;45:61-65.
21. McNab A, Burns B, Bhullar I, et al. A prehospital shock index for trauma correlates with measures of hospital resource use and mortality. Surgery 2014;152:473-476.
22. McNab A, Burns B, Bhullar I, et al. An analysis of shock index as a correlate for outcomes in trauma by age group. Surgery 2013;154:384-387.
23. Neideen T, Lam M, Brasel KJ. Preinjury beta blockers are associated with increased mortality in geriatric trauma patients. J Trauma 2008;65:1016-1020.
24. O'Reilly DJ, Morrison JJ, Jansen JO, et al. Prehospital blood transfusion in the en route management of severe combat trauma: a matched cohort study. J Trauma Acute Care Surg 2014;77 (3 suppl 2):S114-S120.
25. Shackelford SA, Del Junco DJ, Powell-Dunford N, et al. Association of prehospital blood product transfusion during medical evacuation of combat casualties in Afghanistan with acute and 30-day survival. JAMA 2017;318:1581-1591.
26. Huang GS, Dunham CM. Mortality outcomes in trauma patients undergoing prehospital red blood cell transfusion: a systematic literature review. Int J Burns Trauma 2017;7:17-26.
27. Sperry JL, Minei JP, Frankel HL, et al. Early use of vasopressors after injury: caution before constriction. J Trauma 2008;64:9-14.
28. Plurad DS, Talving P, Lam L, et al. Early vasopressor use in critical injury is associated with mortality independent from volume status. J Trauma 2011;71:565-570.
29. Gupta B, Garg N, Ramachandran R. Vasopressors: do they have any role in hemorrhagic shock? J Anaesthesiol Clin Pharmacol 2017;33:3-8.
30. Wang CH, Hsieh WH, Chou HC, et al. Liberal versus restricted fluid resuscitation strategies in trauma patients: a systematic review and meta-analysis of randomized controlled trials and observational studies. Crit Care Med 2014;42:954-961.
2. Saad S, Mohamed N, Moghazy A, et al. Venous glucose, serum lactate and base deficit as biochemical predictors of mortality in patients with polytrauma. Ulus Travma Acil Cerrahi Derg 2016;22:29-33.
3. Charry JD, Bermeo JM, Montoya KF, et al. Shock index as a predictor of mortality in patients with penetrating trauma to the thorax. Rev Colomb Cir 2015;30:24-28.
4. Paladino L, Sinert R, Wallace D, et al. The utility of base deficit and arterial lactate in differentiating major from minor injury in trauma patients with normal vital signs. Resuscitation 2008;77: 363-368.
5. Vincent JL, De Backer D. Circulatory Shock. N Engl J Med 2013;369:1726.
6. Régnier 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. Callaway DW, Shapiro NI, Donnino MW, et al. Serum lactate and base deficit as predictors of mortality in normotensive elderly blunt trauma patients. J Trauma 2009;66:1040-1044.
8. Olaussen A, Blackburn T, Mitra B, et al. Review article: shock index for prediction of critical bleeding post-trauma: a systematic review. Emerg Med Australas 2014;26:223-228.
9. Abramson D, Scalea TM, Hitchcock R, et al. Lactate clearance and survival following injury. J Trauma 1993;35:8-584.
10. Dellinger RP, Levy MM, Rhodes A, et al. Surviving sepsis campaign: international guidelines for management of severe sepsis and septic shock, 2012. Intensive Care Med 2013;39:165-228.
11. Okello M, Makobore P, Wangoda R, et al. Serum lactate as a predictor of early outcomes among trauma patients in Uganda. Int J Emerg Med 2014;7:20.
12. Mutschler M, Nienaber U, Brockamp T, et al. Renaissance of base deficit for the initial assessment of trauma patients: a base deficit-based classification for hypovolemic shock developed on data from 16,305 patients derived from the TraumaRegister DGU*. Crit Care 2013;17:R42.
13. Kruse O, Grunnet N, Barfod C. Blood lactate as a predictor for inhospital mortality in patients admitted acutely to hospital: a systematic review. Scand J Trauma Resusc Emerg Med 2011;19:74.
14. 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.
15. González M, Morales CH, Sanabria Á. Lactate clearance as a prognostic factor in patients with penetrating trauma. Rev Colomb Cir 2016;31:34-43.
16. 0Baxter 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.
17. 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.
18. Dekker SE, de Vries HM, Lubbers WD, et al. Lactate clearance metrics are not superior to initial lactate in predicting mortalityin trauma. Eur J Trauma Emerg Surg 2016;42:1-11.
19. Ibrahim I, Chor WP, Chue KM, et al. Is arterial base deficit still a useful prognostic marker in trauma? A systematic review. Am J Emerg Med 2016;34:626-635.
20. Mitra B, Fitzgerald M, Chan J. The utility of a shock index >1asan indication for pre-hospital oxygen carrier administration in major trauma. Injury 2014;45:61-65.
21. McNab A, Burns B, Bhullar I, et al. A prehospital shock index for trauma correlates with measures of hospital resource use and mortality. Surgery 2014;152:473-476.
22. McNab A, Burns B, Bhullar I, et al. An analysis of shock index as a correlate for outcomes in trauma by age group. Surgery 2013;154:384-387.
23. Neideen T, Lam M, Brasel KJ. Preinjury beta blockers are associated with increased mortality in geriatric trauma patients. J Trauma 2008;65:1016-1020.
24. O'Reilly DJ, Morrison JJ, Jansen JO, et al. Prehospital blood transfusion in the en route management of severe combat trauma: a matched cohort study. J Trauma Acute Care Surg 2014;77 (3 suppl 2):S114-S120.
25. Shackelford SA, Del Junco DJ, Powell-Dunford N, et al. Association of prehospital blood product transfusion during medical evacuation of combat casualties in Afghanistan with acute and 30-day survival. JAMA 2017;318:1581-1591.
26. Huang GS, Dunham CM. Mortality outcomes in trauma patients undergoing prehospital red blood cell transfusion: a systematic literature review. Int J Burns Trauma 2017;7:17-26.
27. Sperry JL, Minei JP, Frankel HL, et al. Early use of vasopressors after injury: caution before constriction. J Trauma 2008;64:9-14.
28. Plurad DS, Talving P, Lam L, et al. Early vasopressor use in critical injury is associated with mortality independent from volume status. J Trauma 2011;71:565-570.
29. Gupta B, Garg N, Ramachandran R. Vasopressors: do they have any role in hemorrhagic shock? J Anaesthesiol Clin Pharmacol 2017;33:3-8.
30. Wang CH, Hsieh WH, Chou HC, et al. Liberal versus restricted fluid resuscitation strategies in trauma patients: a systematic review and meta-analysis of randomized controlled trials and observational studies. Crit Care Med 2014;42:954-961.
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 Apr. 20];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 Apr. 20];46(3):209-17. Available from: https://www.revcolanest.com.co/index.php/rca/article/view/520
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