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Evaluation of Lactate and Lactate Clearance as a Marker of Outcome in Trauma ICU
Hypo-perfusion is usual in patients suffering from traumatic injury that may be indicated by serum lactate elevation. This study was performed to analyze the relation of the lactate value with trauma mortality and its clearance. The research included a total of 202 trauma patients admitted into ICU. Study parameters such as patient demography, injury mechanism, Blood Pressure (BP), heart rate (HR), Glasgow Coma Scale (GCS) and level of lactate in the blood. All these parameters were documented in the first 3 hours of hospitalization, and lactate clearance was recorded between 3 and 9 hours afterwards. For the study point; death up to 7 days was considered as a direct impact of trauma and considered in study. The study was divided into two subgroups, either expired (n=79) or survivors (n=123) according to the final outcome. The mean age, mean body weight, sex ratio, HR, Systolic Blood Pressure (SBP) and Diastolic Blood Pressure (DBP) in both groups were comparable. The difference in lactate at admission, lactate at 6 hours and lactate clearance in between survivors and deaths were found to be insignificant statistically. Among trauma patients there is no significant relationship between lactate admission or lactate clearance and mortality. Higher sample size may be appropriate for definitive proof to be reached.
Keywords
- Murray CJ, Lopez AD. Mortality by cause for eight regions of the world: Global Burden of Disease Study. Lancet. 3 May 1997; 349(9061): 1269–76. https://doi.org/10.1016/S0140-6736(96)07493-4
- DiMaggio C, Ayoung-Chee P, Shinseki M, Wilson C, Marshall G, Lee DC, et al. Traumatic injury in the United States: in-patient epidemiology 2000–2011. Injury. 2016; 47: 1393–403. https://doi.org/10.1016/j.injury.2016.04.002
- Kaplan LJ, Kellum JA. Initial pH, base deficit, lactate, anion gap, strong ion difference, and strong ion gap predict outcome from major vascular injury. Crit Care Med. 2004; 32(5): 1120–1124. https://doi.org/10.1097/01.CCM.0000125517.28517.74
- Blow O, Magliore L, Claridge JA, Butler K, Young JS. The golden hour and the silver day: detection and correction of occult hypo perfusion within 24 hours improves outcome from major trauma. J Trauma. 1999; 47(5): 964–969.https://doi.org/10.1097/00005373-199911000-00028
- Wo CC, Shoemaker WC, Appel PL, Bishop MH, KramHB, Hardin E. Unreliability of blood pressure and heart rate to evaluate cardiac output in emergency resuscitation and critical illness. Crit Care Med. 1993; 21(2): 218–223.https://doi.org/10.1097/00003246-199302000-00012
- Tisherman SA, Barie P, Bokhari F, Bonadies J, Daley B, Diebel L, et al. Clinical practice guideline: endpoints of resuscitation. J Trauma. October 2004; 57(4): 898–912.https://doi.org/10.1097/01.TA.0000133577.25793.E5
- Martin M, Murray J, Berne T, Demetriades D, Belzberg H.Diagnosis of acid-base derangements and mortality prediction in the trauma intensive care unit: the physiochemical approach. J Trauma. 2005; 58(2): 238–243. https://doi.org/10.1097/01.TA.0000152535.97968.4E
- Cerovic O, Golubovic V, Spec-Marn A, Kremzar B, Vidmar G. Relationship between injury severity and lactate levels in severely injured patients. Intensive Care Med. 2003; 29(8):1300–1305. https://doi.org/10.1007/s00134-0031753-8
- Durham RM, Moran JJ, Mazuski JE, Shapiro MJ, Baue AE, Flint LM. Multiple organ failure in trauma patients. J Trauma. 2003; 55(4): 608–616. https://doi.org/10.1097/01.TA.0000092378.10660.D1
- Aslar AK, Kuzu MA, Elhan AH, Tanik A, Hengirmen S. Admission lactate level and the APACHEII score are the most useful predictors of prognosis following torso trauma. Injury. 2004; 35(8): 746–752. https://doi.org/10.1016/j.injury.2003.09.030
- Lavery RF, Livingston DH, Tortella BJ, Sambol JT, Slomovitz BM, Siegel JH. The utility of venous lactate to triage injured patients in the trauma center. J Am Coll Surg. 2000; 190(6): 656–664. https://doi.org/10.1016/S1072-7515(00)00271-4
- Manikis P, Jankowski S, Zhang H, Kahn RJ, Vincent JL. Correlation of serial blood lactate levels to organ failure and mortality after trauma. Am J Emerg Med. 1995; 13(6): 619–622. https://doi.org/10.1016/0735-6757(95)90043-8
- Abramson D, Scalea TM, Hitchcock R, Trooskin SZ, Henry SM, Greenspan J. Lactate clearance and survival following injury. J Trauma. 1993; 35(4): 584–588. https://doi.org/10.1097/00005373-199310000-00014
- Odom SR, Howell MD, Silva GS, Nielsen VM, Gupta A, Shapiro NI, et al. Lactate clearance as a predictor of mortality in trauma patients. J Trauma Acute Care Surg. 2013; 74(4): 999–1004. https://doi.org/10.1097/TA.0b013e3182858a3e
- Moralesa C, Ascuntarc J, Londoñod JM, Niñod CD, Leóna JP, Bernald E, Vargasb C, Jaimes F. Lactate clearance: prognostic mortality marker in trauma patients. 2019; 47(1): 41–48. https://doi.org/10.1097/CJ9.0000000000000084
- Hasegawa D, Nishida K, Hara Y, Kawaji T, Moriyama K, Shimomura Y, Niimi D, Komura H, Nishida O. Differential effect of lactate in predicting mortality in septic patients with or without disseminated intravascular coagulation: a multicenter, retrospective, observational study. J Intensive Care 2019; 7: 35. https://doi.org/10.1186/s40560-0190389-x
- BouChebl R, El Khuri C, Shami A, Rajha E, Faris N, Bachir R, AbouDagher G. Serum lactate is an independent predictor of hospital mortality in critically ill patients in the emergency department: a retrospective study. Scand J Trauma Resusc Emerg Med. 14 Jul 2017; 25(1): 69. https:// doi.org/10.1186/s13049-017-0415-8
- Nguyen HB, Rivers EP, Knoblich BP, Jacobsen G, Muzzin A, Ressler JA, Tomlanovich MC. Early lactate clearance is associated with improved outcome in severe sepsis and septic shock. Crit Care Med. 2004; 32(8): 1637–42. https://doi.org/10.1097/01.CCM.0000132904.35713.A7
- Caputo N, Fraser R, Paliga A, Kanter M, Hosford K, Madlinger R. Triage vital signs do not correlate with serum lactate or base deficit, and are less predictive of operative intervention in penetrating trauma patients: a prospective cohort study. Emerg Med. 2013; 0(7): 546–50. https://doi.org/10.1136/emermed-2012-201343
- Guyette F, Suffoletto B, Castillo J-L, Quintero J, Callaway C, Puyana J-C. Prehospital serum lactate as a predictor of outcomes in trauma patients: a retrospective observational study. J Trauma 2011; 70(4):782–6. https://doi.org/10.1097/ TA.0b013e318210f5c9
- Husain F, Martin JM, Mullenix PD, Steele S, Elliot DC.Serum lactate and base deficit as predictors of mortality and morbidity. Am J Surg. 2003; 185(5): 485–491. https://doi.org/10.1016/S0002-9610(03)00044-8
- Lefering R, Zielske D, Bouillon B, Hauser C, Levy H. Lactic acidosis is associated with multiple organ failure and need for ventilator support in patients with severe hemorrhage from trauma. Eur J Trauma Emerg Surg. 2013; 39(5): 487– 93. https://doi.org/10.1007/s00068-013-0285-3
- Callaway DW, Shapiro NI, Donnino MW, Baker C, Rosen CL. Serum lactate and base deficit as predictors of mortality in normotensive elderly blunt trauma patients. J Trauma. 2009; 66(4): 1040–4. https://doi.org/10.1097/TA.0b013e3181895e9e
- Chana M, Manson J, Davenport R, De’Ath H, Spoors C, Raza I, et al. Time course of lactate clearance in trauma and its relevance to outcomes. Scand J Trauma Resusc Emerg Med; 2012; 20(Suppl 1): O9. https://doi.org/10.1186/17577241-20-S1-O9
- Freitas AD, Franzon O. Lactate as predictor of mortality in polytrauma. Arq Bras Cir Dig. 2015; 28(3): 163–166.https://doi.org/10.1590/S0102-67202015000300004
- Kushimoto S, Akaishi S, Sato T, Nomura R, Fujita M, Kudo D, Kawazoe Y, Yoshida Y, Miyagawa N. Lactate, a useful marker for disease mortality and severity but an unreliable marker of tissue hypoxia/hypoperfusion in critically ill patients. Acute Med Surg. 2016; 3(4): 293-297. https://doi.org/10.1002/ams2.207
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