Mark L Gustafson1, Steve Hollosi2, Julton Tomanguillo Chumbe3, Damayanti Samanta4, Asmita Modak5, Audis Bethea6. 1. Charleston Area Medical Center, General Hospital, Charleston, WV 25301. Electronic address: markgustafsondo@gmail.com. 2. Charleston Area Medical Center, General Hospital, Charleston, WV 25301. Electronic address: stevehollosi@gmail.com. 3. Center for Health Services and Outcomes Research, Charleston Area Medical Center, Charleston, WV 25304. Electronic address: julton.tomanguillochumbe@camc.org. 4. Center for Health Services and Outcomes Research, Charleston Area Medical Center, Charleston, WV 25304. Electronic address: damayanti.samanta@camc.org. 5. Center for Health Services and Outcomes Research, Charleston Area Medical Center, Charleston, WV 25304. Electronic address: asmita.modak@camc.org. 6. Center for Health Services and Outcomes Research, Charleston Area Medical Center, Charleston, WV 25304. Electronic address: audis.bethea@camc.org.
Abstract
OBJECTIVE: The objective of this study was to assess the predictive value of lactate and base deficit in determining outcomes in trauma patients who are positive for ethanol. METHODS: Retrospective cohort study of patients admitted to a level 1 trauma center between 2005 and 2014. Adult patients who had a serum ethanol, lactate, base deficit, and negative urine drug screen obtained upon presentation were included. RESULTS: Data for 2482 patients were analyzed with 1127 having an elevated lactate and 1092 an elevated base deficit. In these subgroups, patients with a positive serum ethanol had significantly lower 72-hour mortality, overall mortality, and hospital length of stay compared with the negative ethanol group. Abnormal lactate (odds ratio [OR], 2.607; 95% confidence interval [CI], 1.629-4.173; P = .000) and base deficit (OR, 1.917; 95% CI, 1.183-3.105; P = .008) were determined to be the strongest predictors of mortality in the ethanol-negative patients. Injury Severity Score was found to be the lone predictor of mortality in patients positive for ethanol (OR, 1.104; 95% CI, 1.070-1.138; P = .000). Area under the curve and Youden index analyses supported a relationship between abnormal lactate, base deficit, and mortality in ethanol-positive patients when the serum lactate was greater than 4.45 mmol/L and base deficit was greater than -6.95 mmol/L. CONCLUSIONS: Previously established relationships between elevated lactate, base deficit, and outcome do not remain consistent in patients presenting with positive serum ethanol concentrations. Ethanol skews the relationship between lactate, base deficit, and mortality thus resetting the threshold in which lactate and base deficit are associated with increased mortality.
OBJECTIVE: The objective of this study was to assess the predictive value of lactate and base deficit in determining outcomes in traumapatients who are positive for ethanol. METHODS: Retrospective cohort study of patients admitted to a level 1 trauma center between 2005 and 2014. Adult patients who had a serum ethanol, lactate, base deficit, and negative urine drug screen obtained upon presentation were included. RESULTS: Data for 2482 patients were analyzed with 1127 having an elevated lactate and 1092 an elevated base deficit. In these subgroups, patients with a positive serum ethanol had significantly lower 72-hour mortality, overall mortality, and hospital length of stay compared with the negative ethanol group. Abnormal lactate (odds ratio [OR], 2.607; 95% confidence interval [CI], 1.629-4.173; P = .000) and base deficit (OR, 1.917; 95% CI, 1.183-3.105; P = .008) were determined to be the strongest predictors of mortality in the ethanol-negative patients. Injury Severity Score was found to be the lone predictor of mortality in patients positive for ethanol (OR, 1.104; 95% CI, 1.070-1.138; P = .000). Area under the curve and Youden index analyses supported a relationship between abnormal lactate, base deficit, and mortality in ethanol-positive patients when the serum lactate was greater than 4.45 mmol/L and base deficit was greater than -6.95 mmol/L. CONCLUSIONS: Previously established relationships between elevated lactate, base deficit, and outcome do not remain consistent in patients presenting with positive serum ethanol concentrations. Ethanol skews the relationship between lactate, base deficit, and mortality thus resetting the threshold in which lactate and base deficit are associated with increased mortality.
Authors: Hadley K Herbert; Tracey A Dechert; Luke Wolfe; Michel B Aboutanos; Ajai K Malhotra; Rao R Ivatury; Therese M Duane Journal: Am Surg Date: 2011-12 Impact factor: 0.688
Authors: Marianne J Vandromme; Russell L Griffin; Jordan A Weinberg; Loring W Rue; Jeffrey D Kerby Journal: J Am Coll Surg Date: 2010-05 Impact factor: 6.113
Authors: Zachary D W Dezman; Angela C Comer; Mayur Narayan; Thomas M Scalea; Jon Mark Hirshon; Gordon S Smith Journal: Injury Date: 2016-03-22 Impact factor: 2.586
Authors: Rolf Rossaint; Bertil Bouillon; Vladimir Cerny; Timothy J Coats; Jacques Duranteau; Enrique Fernández-Mondéjar; Daniela Filipescu; Beverley J Hunt; Radko Komadina; Giuseppe Nardi; Edmund A M Neugebauer; Yves Ozier; Louis Riddez; Arthur Schultz; Jean-Louis Vincent; Donat R Spahn Journal: Crit Care Date: 2016-04-12 Impact factor: 9.097
Authors: Jacob Calvert; Thomas Desautels; Uli Chettipally; Christopher Barton; Jana Hoffman; Melissa Jay; Qingqing Mao; Hamid Mohamadlou; Ritankar Das Journal: Ann Med Surg (Lond) Date: 2016-05-10
Authors: Nadim Mahmud; Sumeet K Asrani; David E Kaplan; Gerald O Ogola; Tamar H Taddei; Patrick S Kamath; Marina Serper Journal: Liver Transpl Date: 2020-12-09 Impact factor: 5.799