Alcohol consumption decreases lactate clearance in acutely injured patients

Dezman, Zachary D.W.; Comer, Angela C.; Narayan, Mayur; Scalea, Thomas M.; Hirshon, Jon Mark; Smith, Gordon S.

doi:10.1016/j.injury.2016.03.007

Cited by 13 publications

(10 citation statements)

References 29 publications

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“…Therefore hypotension, which correlates with septic shock [17] , may be difficult to identify among patients in the AUD subpopulation. Additionally, lactate, a common biomarker test which is used in the recently proposed updated septic shock definition [13] , [26] , may be inaccurate for AUD patients [27] because patients with AUD often suffer from chronic lactic acidosis [28] , [29] . While this study was not meant to explore or explain the pathophysiologic mechanisms of sepsis and failure in AUD patients, it does recognize and attempt to correlate the clinical presentation of these patients and propose methods to identify those at risk for sepsis and septic shock before they have fully manifested themselves.…”

Section: Introductionmentioning

confidence: 99%

High-performance detection and early prediction of septic shock for alcohol-use disorder patients

Calvert

Desautels

Chettipally

et al. 2016

Annals of Medicine &Amp; Surgery

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BackgroundThe presence of Alcohol Use Disorder (AUD) complicates the medical conditions of patients and increases the difficulty of detecting and predicting the onset of septic shock for patients in the ICU.MethodsWe have developed a high-performance sepsis prediction algorithm, InSight, which outperforms existing methods for AUD patient populations. InSight analyses a combination of singlets, doublets, and triplets of clinical measurements over time to generate a septic shock risk score. AUD patients obtained from the MIMIC III database were used in this retrospective study to train InSight and compare performance with the Modified Early Warning Score (MEWS), the Simplified Acute Physiology Score (SAPS II), and the Systemic Inflammatory Response Syndrome (SIRS) for septic shock prediction and detection.ResultsFrom 4-fold cross validation, InSight performs particularly well on diagnostic odds ratio and demonstrates a relatively high Area Under the Receiver Operating Characteristic (AUROC) metric. Four hours prior to onset, InSight had an average AUROC of 0.815, and at the time of onset, InSight had an average AUROC value of 0.965. When applied to patient populations where AUD may complicate prediction methods of sepsis, InSight outperforms existing diagnostic tools.ConclusionsAnalysis of the higher order correlations and trends between relevant clinical measurements using the InSight algorithm leads to more accurate detection and prediction of septic shock, even in cases where diagnosis may be confounded by AUD.

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Section: Introductionmentioning

confidence: 99%

High-performance detection and early prediction of septic shock for alcohol-use disorder patients

Calvert

Desautels

Chettipally

et al. 2016

Annals of Medicine &Amp; Surgery

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“…Lactate can also be taken up by various tissues (brain, heart, muscle) and be directly utilized. Clearance is affected by various factors, including alcohol consumption (dose dependent decrease [22]) and (liver) tissue patency. Many of these are unknown to the clinicians caring for the patient in the prehospital situation.…”

Section: Discussionmentioning

confidence: 99%

Determinants of prehospital lactate in trauma patients: a retrospective cohort study

Avest¹,

Griggs²,

Wijesuriya³

et al. 2020

BMC Emerg Med

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Background: Point of care serum lactate measurement is emerging as an adjunct to prehospital clinical assessment and has the potential to guide triage and advanced treatment decision-making. In this study we aimed to assess which factors potentially affect prehospital lactate levels. Methods: We performed a retrospective cohort study of all trauma patients attended by the Air Ambulance, Kent, Surrey & Sussex (AAKSS) between July 2017 and April 2018 in whom a pre-hospital lactate was measured. Lactate was measured before AAKSS treatments were commenced, but generally after prehospital treatment by ground ambulance crews was initiated. Primary endpoint of interest was the association of various patient-and treatment characteristics with prehospital lactate levels. Results: During the study period, lactate was measured in 156 trauma patients. Median lactate was 3.0 [2.0-4.1] mmol/l. Patients with an elevated lactate more often had deranged indices of end organ perfusion-and oxygenation (shock index 0.80 [0.58-1.03] vs 0.61 [0.40-0.82], p < 0.001, SpO 2 96 [89-100%] vs 98 [96-100%], p = 0.025). They more often suffered from head injuries (62% vs 41%, p = 0.008), and received less analgesia prior to arrival of the AAKSS team (51.6% vs 67.2%, p = 0.03). In multivariate analysis, indices of end organ perfusion-and oxygenation only explained 15% of the variation in lactate levels. Conclusions: Prehospital lactate levels are not solely associated with indices of end organ perfusion-and oxygenation. Injury type, treatments given on scene and many other (unmeasured) factors likely play an important role as well. This should be taken into account when lactate is used in clinical algorithms to guide prehospital triage or treatment.

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“…The normalisation of lactate measured in relation to its clearance (ΔLA) was shown to be associated with a lower risk of early death in ED. Poor relative clearance of lactate is an excellent predictor of the risk of early mortality, ahead of the alteration of vital signs [ 25 ]. Thus, the measurement of lactate clearance can add useful information for the clinical management of critical patients in an ED.…”

Section: Discussionmentioning

confidence: 99%

Clinical Utility of Delta Lactate for Predicting Early In-Hospital Mortality in Adult Patients: A Prospective, Multicentric, Cohort Study

et al. 2020

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One of the challenges in the emergency department (ED) is the early identification of patients with a higher risk of clinical deterioration. The objective is to evaluate the prognostic capacity of ΔLA (correlation between prehospital lactate (pLA) and hospital lactate (hLA)) with respect to in-hospital two day mortality. We conducted a pragmatic, multicentric, prospective and blinded-endpoint study in adults who consecutively attended and were transported in advanced life support with high priority from the scene to the ED. The corresponding area under the receiver operating characteristics curve (AUROC) was obtained for each of the outcomes. In total, 1341 cases met the inclusion criteria. The median age was 71 years (interquartile range: 54–83 years), with 38.9% (521 cases) females. The total 2 day mortality included 106 patients (7.9%). The prognostic precision for the 2 day mortality of pLA and hLA was good, with an AUROC of 0.800 (95% CI: 0.74–0.85; p < 0.001) and 0.819 (95% CI: 0.76–0.86; p < 0.001), respectively. Of all patients, 31.5% (422 cases) had an ΔLA with a decrease of <10%, of which a total of 66 patients (15.6%) died. A lactate clearance ≥ 10% is associated with a lower risk of death in the ED, and this value could potentially be used as a guide to determine if a severely injured patient is improving in response to the established treatment.

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Alcohol consumption decreases lactate clearance in acutely injured patients

Cited by 13 publications

References 29 publications

High-performance detection and early prediction of septic shock for alcohol-use disorder patients

High-performance detection and early prediction of septic shock for alcohol-use disorder patients

Determinants of prehospital lactate in trauma patients: a retrospective cohort study

Clinical Utility of Delta Lactate for Predicting Early In-Hospital Mortality in Adult Patients: A Prospective, Multicentric, Cohort Study

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