Lactate predicts massive transfusion in hemodynamically normal patients

Brooke, Magdalene A.; Yeung, Louise; Miraflor, Emily; Garcia, Arturo; Victorino, Gregory P.

doi:10.1016/j.jss.2016.04.015

Cited by 26 publications

(18 citation statements)

References 37 publications

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“…In this study, lactate levels of 5.0–7.5 mmol/L and >7.5 mmol/L were associated with the need for ≥6 units of PRC [16]. In hemodynamically stable trauma patients, the lactate levels of patients who received MT were higher than were those of patients who did not receive MT (5.6 vs. 2.6 mmol/L); this finding was consistent with that of the present study [17]. Despite hemodynamic stability at the time of hospital admission, the ISS score of the MT group in this study was very high (29 points) [17].…”

Section: Discussionsupporting

confidence: 90%

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The association between the initial lactate level and need for massive transfusion in severe trauma patients with and without traumatic brain injury

et al. 2019

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The association between the initial lactate level and need for massive transfusion in severe trauma patients with and without traumatic brain injury Background: Exsanguination is a major cause of death in severe trauma patients. The purpose of this study was to analyze the prognostic impact of the initial lactate level for massive transfusion (MT) in severe trauma. We divided patients according to subgroups of traumatic brain injury (TBI) and non-TBI. Methods: This single-institution retrospective study was conducted on patients who were admitted to hospital for severe trauma between January 2016 and December 2017. TBI was defined by a head Abbreviated Injury Scale ≥ 3. Receiver operating characteristic analysis was used to analyze the prognostic impact of the lactate level. Multivariate analyses were performed to evaluate the relationship between the MT and lactate level. The primary outcome was MT. Results: Of the 553 patients, MT was performed in 62 patients (11.2%). The area under the curve (AUC) for the lactate level for predicting MT was 0.779 (95% confidence interval [CI], 0.742 to 0.813). The AUCs for lactate level in the TBI and non-TBI patients were 0.690 (95% CI, 0.627 to 0.747) and 0.842 (95% CI, 0.796 to 0.881), respectively. In multivariate analyses, the lactate level was independently associated with the MT (odds ratio [OR], 1.179; 95% CI, 1.070 to 1.299). The lactate level was independently associated with MT in non-TBI patients (OR, 1.469; 95% CI, 1.262 to 1.710), but not in TBI patients. Conclusions: The initial lactate level may be a possible prognostic factor for MT in severe trauma. In TBI patients, however, the initial lactate level was not suitable for predicting MT.

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Section: Discussionsupporting

confidence: 90%

“…Anaerobic metabolism leads to lactate accumulation. Many prior studies have described a relationship between hemorrhage and lactate levels in trauma patients [11,16,17]. Johnson et al [11] showed that the AUC of lactate for predicting hemorrhage >250 ml was 0.824 in trauma patients.…”

Section: Discussionmentioning

confidence: 99%

The association between the initial lactate level and need for massive transfusion in severe trauma patients with and without traumatic brain injury

et al. 2019

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“…In this regard, two studies on trauma patients have been reported. 13,14 According to a study by Brooke and colleagues, 13 lactate is a better predictor concerning blood requirements in trauma patients compared with systolic BP. Another study reported that a lactate concentration of >4 mM L À1 upon admission is a robust predictor of massive transfusion requirement in haemodynamically normal trauma patients.…”

Section: Discussionmentioning

confidence: 99%

Blood lactate concentration and shock index associated with massive transfusion in emergency department patients with primary postpartum haemorrhage

Sohn

Kim

Seo

et al. 2018

British Journal of Anaesthesia

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Point-of-care testing of lactate concentrations in the emergency department may be useful to predict massive transfusion requirements in primary postpartum haemorrhage. Combining initial lactate concentrations with the shock index improves the predictive performance for massive transfusion requirements and may contribute to rapid risk stratification of patients with primary postpartum haemorrhage in need of transfusion and further focus on early interventions to control bleeding.

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“…studied hemodynamically normal trauma patients and found that an admission lactate of >4 mmol/L had a greater need for massive transfusion (MT) and greater blood requirement. [ 10 ]…”

Section: Discussionmentioning

confidence: 99%

“…They concluded that in hemodynamically normal trauma patients, the admission lactate of >4 mmol/L is a robust predictor of longer ICU stay and poor outcomes. [ 10 ]…”

Section: Discussionmentioning

confidence: 99%

A clinical study on the initial assessment of arterial lactate and base deficit as predictors of outcome in trauma patients

Javali

Ravindra

Patil

et al. 2017

Indian Journal of Critical Care Medicine

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Background:Trauma is a leading cause of mortality in India. Outcomes can be improved by early recognition of hemorrhagic shock and expedited management. At present, we rely on traditional vital signs, which are not sensitive measures. Point of care biochemical markers have been emerging as prognostic markers in trauma, but have not been studied in Indian setting.Aims:This study aims to study the association between arterial lactate and base deficit (BD) at emergency department (ED) admission and 24 h outcome in trauma patients at risk of hemodynamic compromise.Materials and Methods:This was a prospective observational study on 100 trauma patients at risk of hemodynamic compromise in tertiary care center ED. Arterial blood gas analysis at admission and 24 h outcomes were noted and statistically analyzed.Results:Arterial lactate ≥4 mmol/L (sensitivity 100% and specificity 85.9%), BD ≥12 mEq/L (sensitivity 87.5% and specificity 82.6%) had more sensitivity than vital signs for predicting 24 h mortality. Higher lactate and BD were associated with increased blood transfusion requirement. Best cutoff values for predicting transfusion were lactate ≥2.9 mmol/L (sensitivity 65.2% and specificity 90.7%), BD ≥8 mEq/L (sensitivity 78.3% and specificity 75.9%). BD-based classification was comparable to ATLS classification in predicting mortality and determining transfusion requirements. Patients with higher arterial lactate and BD were found to have higher 24 h Intensive Care Unit (ICU) admission.Conclusion:Emergency admission arterial lactate and Base Deficit are useful predictors of mortality, need for blood transfusion and ICU admission at 24 h. It can be used to triage, identify shock early, assess transfusion requirement, and prognosticate trauma patients.

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Lactate predicts massive transfusion in hemodynamically normal patients

Cited by 26 publications

References 37 publications

The association between the initial lactate level and need for massive transfusion in severe trauma patients with and without traumatic brain injury

The association between the initial lactate level and need for massive transfusion in severe trauma patients with and without traumatic brain injury

Blood lactate concentration and shock index associated with massive transfusion in emergency department patients with primary postpartum haemorrhage

A clinical study on the initial assessment of arterial lactate and base deficit as predictors of outcome in trauma patients

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