Serial lactate and admission SOFA scores in trauma: an analysis of predictive value in 724 patients with and without traumatic brain injury

Abstract

Objective Arterial lactate, base excess (BE), lactate clearance, and Sequential Organ Failure Assessment (SOFA) score have been shown to correlate with outcome in severely injured patients. The goal of the present study was to separately assess their predictive value in patients suffering from traumatic brain injury (TBI) as opposed to patients suffering from injuries not related to the brain. Materials and methods A total of 724 adult trauma patients with an Injury Severity Score (ISS) C 16 were grouped into patients without TBI (non-TBI), patients with isolated TBI (isolated TBI), and patients with a combination of TBI and non-TBI injuries (combined injuries). The predictive value of the above parameters was then analyzed using both uni-and multivariate analyses. Results The mean age of the patients was 39 years (77 % males), with a mean ISS of 32 (range 16-75). Mortality ranged from 14 % (non-TBI) to 24 % (combined injuries). Admission and serial lactate/BE values were higher in nonsurvivors of all groups (all p \ 0.01), but not in patients with isolated TBI. Admission SOFA scores were highest in nonsurvivors of all groups (p = 0.023); subsequently septic patients also showed elevated SOFA scores (p \ 0.01), except those with isolated TBI. In this group, SOFA score was the only parameter which showed significant differences between survivors and non-survivors. Receiver operating characteristic (ROC) analysis revealed lactate to be the best overall predictor for increased mortality and further septic complications, irrespective of the leading injury. Conclusion Lactate showed the best performance in predicting sepsis or death in all trauma patients except those with isolated TBI, and the differences were greatest in patients with substantial bleeding. Following isolated TBI, SOFA score was the only parameter which could differentiate survivors from non-survivors on admission, although the SOFA score, too, was not an independent predictor of death following multivariate analysis.

The value of blood lactate kinetics in critically ill patients: a systematic review

“… Regnier, 2012 [ 48 ] 281 Prospective – 2 h, 4 h 2 h Early normalization of lactate independent predictor of survival 32. Dubendorfer, 2013 [ 49 ] 724 Retrospective – Variable Variable In patients without traumatic brain injury, decrease in lactate impaired in nonsurvivors 33. Odom, 2013 [ 50 ] 623 Retrospective ≥4 6 h 6 h Lower decrease in lactate at 6 h independently predictive of increased risk of death 34.…”

Lactate on emergency department arrival as a predictor of in-hospital mortality in necrotizing fasciitis: a retrospective study

“…Our results are in line with recently published findings that suggest that blood lactate concentration upon ED arrival is predictive of mortality, independent of SOFA score. Patients with contemporaneous blood lactate and SOFA score measurements at admission were enrolled in limited prospective cohort studies [27, 29, 30]. Our study was conducted in a large mixed cohort of NF patients.…”

Incidence, Predictors, and Adverse Outcomes of Extubation Failure in Young Children with Isolated Traumatic Brain Injury: A Prospective Observational Study

“…Previous adult studies have demonstrated the effects of initial base excess and blood lactate on predicted mortality in brain trauma patients. 14,15 Severe TBI profoundly disturbs cerebral acid-base homeostasis, and brain tissue acidosis can cause further neural death. 16 Acidosis can cause secondary insult to the brain by exacerbation of cerebral edema and further increases the risk of mortality and morbidity.…”