Prognostic use of lactate to predict inpatient mortality in acute gastrointestinal hemorrhage

Shah, Aatman; Chisolm‐Straker, Makini; Alexander, A.; Rattu, Mohammad; Dikdan, Sean; Manini, Alex F.

doi:10.1016/j.ajem.2014.02.010

Cited by 43 publications

(33 citation statements)

References 19 publications

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“…In our study serum lactate levels correlated with mortality risk and levels were significant in the variceal subgroup. This was similar to other western studies (24) . Other scores validated in a few studies are Model for end stage liver disease (MELD) and MELD-Na (25)(26)(27)(28) .…”

Section: Discussionsupporting

confidence: 93%

Clinical Utility of Risk Scores in Variceal Bleeding

Chandnani

Rathi

Udgirkar

et al. 2019

Arq. Gastroenterol.

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BACKGROUND: Variceal bleeding remains important cause of upper gastrointestinal bleed. Various risk scores are used in risk stratification for non-variceal bleed. Their utility in variceal bleeding patients is not clear. This study aims to compare probability of these scores in predicting various outcomes in same population. OBJECTIVE: This study aims to compare probability of these scores in predicting various outcomes in same population. To study characteristics and validate AIMS65, Rockall, Glasgow Blatchford score(GBS), Progetto Nazionale Emorragia Digestiva (PNED) score in variceal Upper Gastrointestinal Bleed (UGIB) patients for predicting various outcomes in our population. METHODS: Three hundred subjects with UGIB were screened prospectively. Of these 141 patients with variceal bleeding were assessed with clinical, blood investigations and endoscopy and risk scores were calculated and compared to non-variceal cases. All cases were followed up for 30 days for mortality, rebleeding, requirement of blood transfusion and need of radiological or surgical intervention. RESULTS: Variceal bleeding (141) was more common than non variceal (134) and 25 had negative endoscopy. In variceal group, cirrhosis (85%) was most common etiology. Distribution of age and sex were similar in both groups. Presence of coffee coloured vomitus (P=0.002), painless bleed (P=0.001), edema (P=0.001), ascites (P=0.001), hemoglobin <7.5 gms (P<0.001), pH<7.35 (P<0.001), serum bicarbonate level <17.6 mmol/L (P<0.001), serum albumin<2.75 gms% (P<0.001), platelet count <1.2 lacs/µL (P<0.001), high INR 1.35 (P<0.001), BUN >25mmol/L (P<0.001), and ASA status (P<0.001), high lactate >2.85 mmol/L (P=0.001) were significant. However, no factor was found significant on multivariate analysis. Rockall was found to be significant in predicting mortality and rebleed. AIMS65 was also significant in predicting mortality. GBS was significant in predicting blood transfusion and need of intervention. PNED score was significant in all events except mortality. CONCLUSION: All four scores had lower predictive potential in predicting events in variceal bleed. However, AIMS65 & Rockall score were significant in predicting mortality, while GBS in predicting need of transfusion and intervention. PNED score was significant in all events except mortality.

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Section: Discussionsupporting

confidence: 93%

Clinical Utility of Risk Scores in Variceal Bleeding

Chandnani

Rathi

Udgirkar

et al. 2019

Arq. Gastroenterol.

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“…Furthermore, elevated serum lactate level on presentation to the ED with acute gastrointestinal hemorrhage was found to be associated with higher in-hospital mortality and it was independently correlated with death (11).…”

Section: Discussionmentioning

confidence: 96%

“…Also, some patients with acute gastrointestinal hemorrhage have an abnormally elevated lactate level, despite normal hematocrit and heart rate, which point to the potential use of lactate level to identify occultly ill patients (11). Besides tissue hypoxia, other mechanisms have been proposed for lactic acidosis in the setting of sepsis (20,21).…”

Section: Discussionmentioning

confidence: 99%

“…Several scoring systems have been developed to predict outcomes after UGIB, but none of these scoring systems used serum lactate level as a predictor of outcomes (6)(7)(8). Although it is well known that in severe sepsis a high serum lactate level is associated with mortality independent of organ dysfunction and shock, the knowledge about the role of serum lactate level upon admission in predicting outcomes in patients with UGIB is still evolving (5,(9)(10)(11). We hypothesized that the use of serum lactate level upon admission can be a valuable tool for the prediction of outcomes in patients with upper gastrointestinal hemorrhage.…”

Section: Introductionmentioning

confidence: 99%

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

El‐Kersh

Chaddha

Sinha

et al. 2015

The Journal of Emergency Medicine

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“…Only one previous study has indicated the usefulness of lactate for prognostication purposes. Shah et al (17) reported that a lactate level of greater than 4 mmol/L was associated with a 6.4-fold increased OR for in-hospital mortality, with 94% specificity and 33% sensitivity. However, these authors included hemodynamically unstable patients, as well as patients with upper and lower gastrointestinal hemorrhage and even liver cirrhosis, all of which can affect lactate values.…”

Section: Discussionmentioning

confidence: 99%