BACKGROUND: Lactate has been shown to be a prognostic biomarker in trauma. Although lactate clearance has already been proposed as an intermediate endpoint in randomized trials, its precise role in trauma patients remains to be determined. METHODS: Blood lactate levels and lactate clearance (LC) were calculated at admission and 2 and 4 h later in trauma patients. The association of initial blood lactate level and lactate clearance with mortality was tested using receiver-operating characteristics curve, logistic regression using triage scores, Trauma Related Injury Severity Score as a reference standard, and reclassification method. RESULTS: The authors evaluated 586 trauma patients (mean age 38±16 yr, 84% blunt and 16% penetrating, mortality 13%). Blood lactate levels at admission were elevated in 327 (56%) patients. The lactate clearance should be calculated within the first 2 h after admission as LC0-2 h was correlated with LC0-4 h (R=0.55, P<0.001) but not with LC2-4 h (R=0.04, not significant). The lactate clearance provides additional predictive information to initial blood lactate levels and triage scores and the reference score. This additional information may be summarized using a categorical approach (i.e., less than or equal to -20 %/h) in contrast to initial blood lactate. The results were comparable in patients with high (5 mM/l or more) initial blood lactate. CONCLUSIONS: Early (0-2 h) lactate clearance is an important and independent prognostic variable that should probably be incorporated in future decision schemes for the resuscitation of trauma patients.
BACKGROUND:Lactate has been shown to be a prognostic biomarker in trauma. Although lactate clearance has already been proposed as an intermediate endpoint in randomized trials, its precise role in traumapatients remains to be determined. METHODS: Blood lactate levels and lactate clearance (LC) were calculated at admission and 2 and 4 h later in traumapatients. The association of initial blood lactate level and lactate clearance with mortality was tested using receiver-operating characteristics curve, logistic regression using triage scores, Trauma Related Injury Severity Score as a reference standard, and reclassification method. RESULTS: The authors evaluated 586 traumapatients (mean age 38±16 yr, 84% blunt and 16% penetrating, mortality 13%). Blood lactate levels at admission were elevated in 327 (56%) patients. The lactate clearance should be calculated within the first 2 h after admission as LC0-2 h was correlated with LC0-4 h (R=0.55, P<0.001) but not with LC2-4 h (R=0.04, not significant). The lactate clearance provides additional predictive information to initial blood lactate levels and triage scores and the reference score. This additional information may be summarized using a categorical approach (i.e., less than or equal to -20 %/h) in contrast to initial blood lactate. The results were comparable in patients with high (5 mM/l or more) initial blood lactate. CONCLUSIONS: Early (0-2 h) lactate clearance is an important and independent prognostic variable that should probably be incorporated in future decision schemes for the resuscitation of traumapatients.
Authors: S E Dekker; H-M de Vries; W D Lubbers; P M van de Ven; E J Toor; F W Bloemers; L M G Geeraedts; P Schober; C Boer Journal: Eur J Trauma Emerg Surg Date: 2016-10-13 Impact factor: 3.693
Authors: Adam Z Tobias; Francis X Guyette; Christopher W Seymour; Brian P Suffoletto; Christian Martin-Gill; Jorge Quintero; Jeffrey Kristan; Clifton W Callaway; Donald M Yealy Journal: Prehosp Emerg Care Date: 2014-02-18 Impact factor: 3.077
Authors: James R Baylis; Alexander E St John; Xu Wang; Esther B Lim; Matthew L Statz; Diana Chien; Eric Simonson; Susan A Stern; Richard T Liggins; Nathan J White; Christian J Kastrup Journal: Shock Date: 2016-09 Impact factor: 3.454
Authors: Zachary D W Dezman; Angela C Comer; Gordon S Smith; Mayur Narayan; Thomas M Scalea; Jon Mark Hirshon Journal: J Trauma Acute Care Surg Date: 2015-10 Impact factor: 3.313