Predicting the Occurrence of Hypotension in Stable Patients With Nonvariceal Upper Gastrointestinal Bleeding

Abstract

Point-of-care testing of lactate can predict in-hospital occurrence of hypotension in stable patients with acute nonvariceal upper gastrointestinal bleeding. However, subsequently, prospective validate research will be required to clarify this.

Trying to Improve on Good Is Not Always Better*

“…The common endpoint to all of the studies has been the risk of mortality. The area under the curve for the receiver operating characteristics for all four of these risk stratification modalities is in excess of 0.80 (5)(6)(7)(8), suggesting that each is similar in their ability to predict the risk of death. Given the equipoise within the recent literature, it is difficult to conclude that anyone test is clearly superior over another.…”

“…A comparison of outcomes between patients who did and did not develop hypotension versus those with a serum lactate above versus below 2.5 mmol/L shows that the differences between the groups were more pronounced when hypotension was used to define risk (6). Given that the mean time to onset of hypotension was 95 minutes, the role of an early lactate may be minimal because most patients go on to develop hypotension shortly after presentation to the emergency department, and even early point of care testing for lactate provides limited lead time to effect the timing of interventions.…”

“…Building upon the observation that the absence of hypotension generally portends better outcomes, in this issue of Critical Care Medicine, Dr. Ko et al (6) proposed that a serum lactate could adequately risk stratify patients who might otherwise be considered to be low risk. The authors used a relatively novel primary endpoint of development of subsequent hypotension.…”

Prognostic Factors in Emergency Department Patients with Glyphosate Surfactant Intoxication: Point‐of‐Care Lactate Testing

“…In recent years, point‐of‐care testing of lactate has become available in the ED, and its rapid availability and accuracy have been validated in several studies . However, little is known about how lactate levels can be used in the prognosis of acute glyphosate surfactant poisoning.…”

“…In recent years, point-of-care testing of lactate has become available in the ED, and its rapid availability and accuracy have been validated in several studies [16]. However, little is Several studies have suggested that advanced age is a predictor of serious complications and mortality in glyphosate surfactant poisoning [4,5,14].…”