R Lefering1, D Zielske2,3, B Bouillon4, C Hauser5, H Levy6. 1. Institute for Research in Operative Medicine (IFOM), Medical Faculty, University Witten/Herdecke, Cologne Medical Center, Ostmerheimer Str. 200, 51109, Cologne, Germany. rolf.lefering@uni-wh.de. 2. Institute for Research in Operative Medicine (IFOM), Medical Faculty, University Witten/Herdecke, Cologne Medical Center, Ostmerheimer Str. 200, 51109, Cologne, Germany. dzielske@sangart.com. 3. Sangart, Inc., San Diego, CA, USA. dzielske@sangart.com. 4. Department of Trauma and Orthopedic Surgery, University Witten/Herdecke, Cologne Merheim Medical Center, Cologne, Germany. bouillonb@kliniken-koeln.de. 5. Harvard Medical School, Boston, MA, USA. cjhauser@bidmc.harvard.edu. 6. Sangart, Inc., San Diego, CA, USA. hlevy@sangart.com.
Abstract
PURPOSE: Lactate is a biomarker for hypoperfusion and subsequent resuscitation in trauma. It is also a predictor of mortality, but few studies have correlated lactate levels with relevant morbidities after trauma. METHODS: A retrospective review was performed of severely injured trauma patients entered into the Trauma Registry of the German Society for Trauma Surgery (TR-DGU) between 2002 and 2008. Adults requiring intensive care were categorized into two groups: lactate and no lactate. The lactate group had three subgroups: normal, elevated, and high lactate. Mean multiple organ failure (MOF) rates and composite endpoint of time (days) to complete organ failure resolution (CTCOFR) for 14 and 21 days and ventilator-free days (VFD) were compared, as well as other endpoints. RESULTS: We analyzed 2,949 patients, of which 1,199 had lactate measurements. The percentage of patients with MOF increased in each higher lactate subgroup (p < 0.001), as did the mean CTCOFR14 and CTCOFR21 scores (p < 0.001 and < 0.001, respectively). Conversely, the mean VFD decreased in each higher lactate subgroup (p < 0.001). Thus, patients in the elevated and high lactate subgroups had greater MOF rates; required more days, on average, to resolve organ failure; and required more days of ventilator support than patients in the normal lactate subgroup. CONCLUSION: Elevated blood lactate levels from trauma were closely correlated with worse outcomes. Thus, lactate shows promise as a biomarker for resuscitation as well as a predictor of mortality. Furthermore, this study supports its use in critical care trials as an outcome measure.
PURPOSE:Lactate is a biomarker for hypoperfusion and subsequent resuscitation in trauma. It is also a predictor of mortality, but few studies have correlated lactate levels with relevant morbidities after trauma. METHODS: A retrospective review was performed of severely injured traumapatients entered into the Trauma Registry of the German Society for Trauma Surgery (TR-DGU) between 2002 and 2008. Adults requiring intensive care were categorized into two groups: lactate and no lactate. The lactate group had three subgroups: normal, elevated, and high lactate. Mean multiple organ failure (MOF) rates and composite endpoint of time (days) to complete organ failure resolution (CTCOFR) for 14 and 21 days and ventilator-free days (VFD) were compared, as well as other endpoints. RESULTS: We analyzed 2,949 patients, of which 1,199 had lactate measurements. The percentage of patients with MOF increased in each higher lactate subgroup (p < 0.001), as did the mean CTCOFR14 and CTCOFR21 scores (p < 0.001 and < 0.001, respectively). Conversely, the mean VFD decreased in each higher lactate subgroup (p < 0.001). Thus, patients in the elevated and high lactate subgroups had greater MOF rates; required more days, on average, to resolve organ failure; and required more days of ventilator support than patients in the normal lactate subgroup. CONCLUSION: Elevated blood lactate levels from trauma were closely correlated with worse outcomes. Thus, lactate shows promise as a biomarker for resuscitation as well as a predictor of mortality. Furthermore, this study supports its use in critical care trials as an outcome measure.
Entities:
Keywords:
Hemorrhage; Lactate; Morbidity; Mortality; Multiple organ failure; Ventilator-free days
Authors: J L Vincent; A de Mendonça; F Cantraine; R Moreno; J Takala; P M Suter; C L Sprung; F Colardyn; S Blecher Journal: Crit Care Med Date: 1998-11 Impact factor: 7.598
Authors: H Bryant Nguyen; Emanuel P Rivers; Bernhard P Knoblich; Gordon Jacobsen; Alexandria Muzzin; Julie A Ressler; Michael C Tomlanovich Journal: Crit Care Med Date: 2004-08 Impact factor: 7.598