Inclusion of lactate level measured upon emergency room arrival in trauma outcome prediction models improves mortality prediction: a retrospective, single-center study

Abstract

Background: This study aimed to develop a model for predicting trauma outcomes by adding arterial lactate levels measured upon emergency room (ER) arrival to existing trauma injury severity scoring systems. Methods: We examined blunt trauma cases that were admitted to our hospital during 2010-2014. Eligibility criteria were cases with an Injury Severity Score of ≥ 9, complete Trauma and Injury Severity Score (TRISS) variable data, and lactate levels that were assessed upon ER arrival. Survivor and non-survivor groups were compared and lactate-based prediction models were generated using logistic regression. We compared the predictive performances of traditional prediction models (Revised Trauma Score [RTS] and TRISS) and lactate-based models using the area under the curve (AUC) of receiver operating characteristic curves. Results: We included 829 patients, and the in-hospital mortality rate among these patients was 21.6%. The model that used lactate levels and age provided a significantly better AUC value than the RTS model. The model with lactate added to the TRISS variables provided the highest Youden J statistic, with 86.0% sensitivity and 70.8% specificity at a cutoff value of 0.15, as well as the highest predictive value, with a significantly higher AUC than the TRISS. Conclusions: These findings indicate that lactate testing upon ER arrival may help supplement or replace traditional physiological parameters to predict mortality outcomes among Korean trauma patients. Adding lactate levels also appears to improve the predictive abilities of existing trauma outcome prediction models.

Plasma interleukin responses as predictors of outcome stratification in patients after major trauma: a prospective observational two centre study

“…While no significant differences were seen in CRP on day 5, plasma [lactate] was higher in the group developing worsening organ functions (Figure 2). Serum [lactate] in particular has been highlighted as a useful predictor of clinical outcome in trauma patients (48)(49)(50)(51). These studies, however, were almost uniformly undertaken in the emergency departments and hence would have been a marker of severity of shock and the quality of care in the pre-hospital environment.…”

Admission Lactate and Base Deficit in Predicting Outcomes of Pediatric Trauma

“…Decision-making on hemorrhage-related procedures is based on clinical findings, diagnostic imaging results, and the surgeon's experience. This mental process, which is hardly predictable using vital signs and trauma scores (3,25), may be facilitated by analyzing BD. This utility is proven by the transfusions and surgical interventions undergone by the 40 and 13 children with BDs of 6.1 to 10.0 mmol/L and lactates of 5.1 mmol/L or lower, respectively (Table 3).…”

“…More than a 30% blood loss reduces oxygen delivery and enhances anaerobic glycolysis, leading to tissue hypoperfusion manifesting as lactic acidosis. Based on this causation, lactic acidosis is associated with trauma mortality (1)(2)(3). Despite the implications of lactate in mortality, base deficit (BD) has been used as a surrogate marker of lactic acidosis because BD is automatically calculated and readily available in point-of-care blood gas reports (4).…”