Predictive Role of Admission Lactate Level in Critically Ill Patients with Acute Upper Gastrointestinal Bleeding

El‐Kersh, Karim; Chaddha, Udit; Sinha, Rahul; Saad, Mohamed; Cavallazzi, Rodrigo

doi:10.1016/j.jemermed.2015.04.008

Cited by 37 publications

(27 citation statements)

References 29 publications

(32 reference statements)

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“…Prior studies have reported increased mortality associated with an elevated lactate level in patients with acute GIB. 16 – 18 Wada et al 19 found that low lactate clearance was associated with an increased risk of active bleeding in patients with upper GIB. Active bleeding could partly explain higher rates of ICU admissions, transfusions, and endoscopies in patients with an elevated lactate level.…”

Section: Discussionmentioning

confidence: 99%

Elevated lactate level predicts intensive care unit admissions, endoscopies and transfusions in patients with acute gastrointestinal bleeding

Shrestha¹,

Borgstrom²,

Trowers³

2018

CEG

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Background and aimsInitial clinical management decision in patients with acute gastrointestinal bleeding (GIB) is often based on identifying high- and low-risk patients. Little is known about the role of lactate measurement in the triage of patients with acute GIB. We intended to assess if lactate on presentation is predictive of need for intervention in patients with acute GIB.Patients and methodsWe performed a single-center, retrospective, cross-sectional study including patients ≥18 years old presenting to emergency with acute GIB between January 2014 and December 2014. Intensive care unit (ICU) admission, inpatient endoscopy (upper endoscopy and/or colonoscopy), and packed red blood cell (PRBC) transfusion were assessed as outcomes. Analyses included univariate and multivariate logistic regression analyses.ResultsOf 1,237 patients with acute GIB, 468 (37.8%) had venous lactate on presentation. Of these patients, 165 (35.2%) had an elevated lactate level (>2.0 mmol/L). Patients with an elevated lactate level were more likely to be admitted to ICU than patients with a normal lactate level (adjusted odds ratio [AOR] 2.96, 95% confidence interval [CI] 1.74–5.01; p<0.001). Patients with an elevated lactate level were more likely to receive PRBC transfusion (AOR 3.65, 95% CI 1.76–7.55; p<0.001) and endoscopy (AOR 1.64, 95% CI 1.02–2.65; p=0.04) than patients with a normal lactate level.ConclusionElevated lactate level predicts the need for ICU admissions, transfusions, and endoscopies in patients with acute GIB. Lactate measurement may be a useful adjunctive test in the triage of patients with acute GIB.

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Section: Discussionmentioning

confidence: 99%

Elevated lactate level predicts intensive care unit admissions, endoscopies and transfusions in patients with acute gastrointestinal bleeding

Shrestha¹,

Borgstrom²,

Trowers³

2018

CEG

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“…Although lactate has a prognostic role in patients with NVUGIB, the optimal lactate level or clearance remains to be determined ( 11 12 13 14 ). Presently, higher LCR (%/hr) within 24 hours after admission was associated with lower 30-day rebleeding rate.…”

Section: Discussionmentioning

confidence: 99%

“…Lactate has been used to predict the severity of illness and risk of mortality in many diseases like sepsis, trauma, cancer, and pediatric cardiac diseases ( 10 ). Recent studies have demonstrated that lactate is associated with prognosis in patients with upper gastrointestinal bleeding (UGIB) ( 11 12 13 ). Although serum lactate level and lactate clearance rate (LCR) have been evaluated as means to evaluate risk evaluation in patients with UGIB, optimal parameter of lactate for risk evaluation remains unclear.…”

Section: Introductionmentioning

confidence: 99%

Lactate Parameters Predict Clinical Outcomes in Patients with Nonvariceal Upper Gastrointestinal Bleeding

et al. 2017

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The predictive role of lactate in patients with nonvariceal upper gastrointestinal bleeding (NVUGIB) has been suggested. This study evaluated several lactate parameters in terms of predicting outcomes of bleeding patients and sought to establish a new scoring model by combining lactate parameters and the AIMS65 score. A total of 114 patients with NVUGIB who underwent serum lactate level testing at least twice and endoscopic hemostasis within 24 hours after admission were retrospectively analyzed. The associations between five lactate parameters and clinical outcomes were evaluated and the predictive power of lactate parameter combined AIMS65s (L-AIMS65s) and AIMS56 scoring was compared. The most common cause of bleeding was gastric ulcer (48.2%). Lactate clearance rate (LCR) was associated with 30-day rebleeding (odds ratio [OR], 0.931; 95% confidence interval [CI], 0.872–0.994; P = 0.033). Initial lactate (OR, 1.313; 95% CI, 1.050–1.643; P = 0.017), maximal lactate (OR, 1.277; 95% CI, 1.037–1.573; P = 0.021), and average lactate (OR, 1.535; 95% CI, 1.137–2.072; P = 0.005) levels were associated with 30-day mortality. Initial lactate (OR, 1.213; 95% CI, 1.027–1.432; P = 0.023), maximal lactate (OR, 1.271; 95% CI, 1.074–1.504; P = 0.005), and average lactate (OR, 1.501; 95% CI, 1.150–1.959; P = 0.003) levels were associated with admission over 7 days. Although L-AIMS65s showed the highest area under the curve for prediction of each outcome, differences between L-AIMS65s and AIMS65 did not reach statistical significance. In conclusion, lactate parameters have a prognostic role in patients with NVUGIB. However, they do not increase the predictive power of AIMS65 when combined.

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“…Correspondingly, recent studies have found some risk factors independently predicting adverse outcomes. These risk factors include: history of peptic ulcer [3], increase in BUN [4], hemodynamic instability, lower serum sodium, hemoglobin and platelet count [5,6], combination of tumor and NSAIDs, liver cirrhosis and coagulopathy [7,8], higher serum bilirubin, creatinine [9], lactate [10,11] and lower serum albumin [12].…”

Section: Introductionmentioning

confidence: 99%

“…Relatively, modifying these scoring systems by adding risk factors that independently predict adverse outcomes, have been investigated in several studies [10,11]. As mentioned earlier, hypoalbuminemia is considered to be a risk factor for more adverse outcome [12]; However an optimal cut off for maximizing the predictive ability of albumin seems to be different in studies [21][22][23].…”

Section: Introductionmentioning

confidence: 99%

Comparison of three risk scores to predict outcomes in upper gastrointestinal bleeding; modifying Glasgow-Blatchford with albumin

Shafaghi¹,

Gharibpoor

Mahdipour

et al. 2019

Romanian Journal of Internal Medicine

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Introduction. Management of upper gastrointestinal bleeding (UGIB) is of great importance. In this way, we aimed to evaluate the performance of three well known scoring systems of AIMS65, Glasgow-Blatchford Score (GBS) and Full Rockall Score (FRS) in predicting adverse outcomes in patients with UGIB as well as their ability in identifying low risk patients for outpatient management. We also aimed to assess whether changing albumin cutoff in AIMS65 and addition of albumin to GBS add predictive value to these scores. Methods. This was a retrospective study on adult patients who were admitted to Razi hospital (Rasht, Iran) with diagnosis of upper gastrointestinal bleeding between March 21, 2013 and March 21, 2017. Patients who didn’t undergo endoscopy or had incomplete medical data were excluded. Initially, we calculated three score systems of AIMS65, GBS and FRS for each patient by using initial Vital signs and lab data. Secondary, we modified AIMS65 and GBS by changing albumin threshold from <3.5 to <3.0 in AIMS65 and addition of albumin to GBS, respectively. Primary outcomes were defined as in hospital mortality, 30-day rebleeding, need for blood transfusion and endoscopic therapy. Secondary outcome was defined as composition of primary outcomes excluding need for blood transfusion. We used AUROC to assess predictive accuracy of risk scores in primary and secondary outcomes. For albumin-GBS model, the AUROC was only calculated for predicting mortality and secondary outcome. The negative predictive value for AIMS65, GBS and modified AIMS65 was then calculated. Result. Of 563 patients, 3% died in hospital, 69.4% needed blood transfusion, 13.1% needed endoscopic therapy and 3% had 30-day rebleeding. The leading cause of UGIB was erosive disease. In predicting composite of adverse outcomes all scores had statistically significant accuracy with highest AUROC for albumin-GBS. However, in predicting in hospital mortality, only albumin-GBS, modified AIMS65 and AIMS65 had acceptable accuracy. Interestingly, albumin, alone, had higher predictive accuracy than other original risk scores. None of the four scores could predict 30-day rebleeding accurately; on the contrary, their accuracy in predicting need for blood transfusion was high enough. The negative predictive value for GBS was 96.6% in score of ≤2 and 85.7% and 90.2% in score of zero in AIMS65 and modified AIMS65, respectively. Conclusion. Neither of risk scores was highly accurate as a prognostic factor in our population; however, modified AIMS65 and albumin-GBS may be optimal choice in evaluating risk of mortality and general assessment. In identifying patient for safe discharge, GBS ≤ 2 seemed to be advisable choice.

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Predictive Role of Admission Lactate Level in Critically Ill Patients with Acute Upper Gastrointestinal Bleeding

Cited by 37 publications

References 29 publications

Elevated lactate level predicts intensive care unit admissions, endoscopies and transfusions in patients with acute gastrointestinal bleeding

Elevated lactate level predicts intensive care unit admissions, endoscopies and transfusions in patients with acute gastrointestinal bleeding

Lactate Parameters Predict Clinical Outcomes in Patients with Nonvariceal Upper Gastrointestinal Bleeding

Comparison of three risk scores to predict outcomes in upper gastrointestinal bleeding; modifying Glasgow-Blatchford with albumin

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