Base deficit as an early marker of coagulopathy in trauma

Abstract

BD but not lactate correlates with the development of the coagulopathy of trauma. The ISS showed a significant correlation with coagulation disturbances, and the combination of hypoperfusion and coagulopathy was associated with a significant increase in mortality.

Comparing biomarkers of traumatic shock: the utility of anion gap, base excess, and serum lactate in the ED

“…Accepted and validated markers include anion gap, serum lactate and base excess which are readily available by venous or arterial draws. Lactate has been shown to be correlated to the amount of carbon dioxide generated during hemorrhagic shock 22 . Base excess (derived from an equation that includes HCO3 and pH) is an estimation of the amount of bicarbonate produced in the blood in that it is the amount of base or acid required to return 1 liter of whole blood to a pH 7.4 and is impacted by factors that raise or lower the pH (such as high anion gap metabolic acidosis which can be caused by a lactic acidosis).…”

Elevated Admission Base Deficit Is Associated with a Complex Dynamic Network of Systemic Inflammation Which Drives Clinical Trajectories in Blunt Trauma Patients

“…Multiple studies have validated the usefulness of blood lactate and BD in trauma patients as markers of injury severity [25–28], as endpoints of resuscitation [20, 29], as a means to monitor treatment efficacy [30–32], and as predictors of outcome [33–36]. Despite indicating the severity of hypoperfusion [37, 38], measurement of lactate alone may not fully encompass the extent of the underlying metabolic acidosis [39]. On the contrary, BD can quantify the extent of both anaerobic and aerobic acidosis and may be a better clinical indicator for the global assessment of the metabolic acid-base status [32, 39–41].…”

“…Despite indicating the severity of hypoperfusion [37, 38], measurement of lactate alone may not fully encompass the extent of the underlying metabolic acidosis [39]. On the contrary, BD can quantify the extent of both anaerobic and aerobic acidosis and may be a better clinical indicator for the global assessment of the metabolic acid-base status [32, 39–41]. In addition, prior studies have suggested that elevated arterial BD (≥4 mEq/L) upon admission after injury can be a reliable predictor of multiple organ dysfunction, morbidity, and mortality in moderately/severely injured patients [21, 34, 36, 42–44].…”

Acute traumatic coagulopathy

“…ATC occurs in approximately 25% of trauma patients 5 and may manifest as abnormal coagulation within 30 minutes following traumatic wounding, 6 a time span and condition not associated with significant fibrinogen consumption and before iatrogenic hemodilution caused by resuscitative efforts. 7 The international normalized ratio (INR), which strongly correlates with a lack of adequate tissue blood flow in surgical and trauma patients, 8 is the most commonly used indicator of ATC. However, information provided by the INR, while more sensitive to coagulation factor activity and thrombin generation, is correlative at best and does not reflect platelet function or red blood cell (RBC) influence.…”