Study of initial blood lactate and delta lactate as early predictor of morbidity and mortality in trauma patients

Abstract

ABSTRACTBackground It has been demonstrated that lactate is a predictive indicator in trauma. It is yet unclear how non-normalization of lactate affects trauma victims.Methods In trauma patients, blood lactate levels were measured at admission and every 2 hours after that. A multivariate logistic regression analysis was conducted to identify the crucial variables to evaluate hospital mortality risk factors.Results 519 patients with trauma were assessed. Male patients (79%, n = 409) who were mostly young (42±20 years old) and had no comorbidities (ASA 1) made up the majority of the patient population. Patients who had normalization of serum lactate in the first 24 hours represented 76% (n = 392) of all trauma patients. Male patient status (OR = 2.2 (1.1–4.6)) and blood alcohol level (OR = 0.64 (0.44–0.91)) were independently linked in a logistic regression model with the failure of serum lactate to normalize in trauma patients over the initial 24 hours. Three variables were independently associated with hospital mortality: a GCS >9 (OR = 0.78(0.61–0.96)), and a pH> 7.37 (OR = 0.0028(0.00066–0.52)) at admission were protecting factors. One of the main risks for death in the pre-field was cardiorespiratory arrest (OR = 62 (2.2–4400)). Hospital mortality was not related to non-normalization of serum lactate in the initial 24 hours (OR = 1.8(0.4–7.9)).Conclusions Although serum lactate at admission is associated to trauma patient prognosis, our study failed to show that non-normalization of serum lactate in the initial 24 hours was a factor that could predict hospital mortality. A future study focusing on normalizing serum lactate in a shorter scale of time could be interesting.

Keywords

• Lactates
• patient prognosis
• trauma