Early prognostic capacity of serum lactate for severe postpartum hemorrhage (SPPH)

Abstract

Introduction25% of maternal deaths worldwide are due to postpartum hemorrhage (PPH)1. Tissue hypoperfusion causes anaerobic respiration and lactic acid production. Lactate measurement has shown prognostic utility in different clinical conditions as severe sepsis and polytrauma.ObjectiveTo Determine whether the concentration of serum lactate measured at the diagnosis of postpartum hemorrhage indicates the development of severe hemorrhage.Material and MethodologyA prognostic cohort study was carried out including 30 patients in vaginal labor and cesarean section who presented bleeding ≥ 500 ml measured by gravimetric method. A venous blood sample was taken for analysis of serum lactate. Those with a total loss of ≥ 1500 ml at the end of labor were classified with severe bleeding. The relationship between serum lactate elevation and development of severe hemorrhage (SPPH) was analyzed by chi‐square and odds ratio was calculated. The best cut point was determined by Curve‐ROC, and its prognostic capacity was compared with the cut‐off point of 2.2 mmol/l as used in ATLS.ResultsThirty patients were analyzed. General average volume of bleeding: 1260 + 691 ml; in severe group was 1700 + 690 ml and 1100 + 224 ml in non‐severe, p = 0.0004. General average serum lactate: 2.68 + 1.8 mmol/l; in severe group 3.24 + 3 mmol/l vs non‐severe 2.28 + 0.54 mmol/l, p = 0.0120. The cut point that best differentiates the groups was 2.6 mmol/l, OR of 12.50 (1.34–116.8), p = 0.017; sensitivity: 0.71 (0.29–0.96); specificity 0.83 (0.52–0.98) and AUC = 0.74 for severe hemorrhage.ATLS cut point of 2.2 mmol/l had RR of 3.65 (0.57,23.37), OR 6.55 (0.68, 63.33, 0.077 sensibility of 0.92 (0.64, 1.00), specificity of 0.35 (0.14, 0.62) positive predictive value of. 1.43 (0.97, 2.10)Support or Funding InformationConsejo Nacional de Ciencia y Tecnología (CONACYT) COMPARATIVE TABLE Cut points RR OR P VALOR Sensibilidad Especificidad PPV 2.2 3.65 (0.57, 23.37) 6.55 (0.68, 63.33) 0.077 0.92 (0.64, 1.00) 0.35 (0.14, 0.62) 1.43 (0.97, 2.10) 2.6 5.50 (1.46, 20.71) 17.88 (2.73, 116.88) <0.001*** 0.85 (0.55, 0.98) 0.76 (0.50, 0.93) 3.60 (1.48, 8.74) RR: RELATIVE RISK OR: ODDS RATIO PPV: POSITIVE PROGNOSTIC VALUE This abstract is from the Experimental Biology 2019 Meeting. There is no full text article associated with this abstract published in The FASEB Journal.