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

Abstract

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.

Prehospital Lactate Levels Obtained in the Ambulance and Prediction of 2-Day In-Hospital Mortality in Patients With Traumatic Brain Injury

“…Prehospital lactate levels have been shown to be useful in detecting high-risk patients, supporting bedside decisionmaking processes, have emerged as a promising prognostic biomarker, [21][22][23] and have started to be adopted in polytraumatized patients. 15 Selected trials have analyzed the association of lactate levels with transfusion requirements in patients with TBI 24 or intracranial pressure 25 and with the development of postcraniotomy neurologic impairment 26 or tested the role of glucose and lactate levels in predicting postinjury cognitive recovery in patients with severe TBI, as these levels correspond to increased lactate thresholds and worse outcomes. 27 To our knowledge, no previous study has specifically evaluated the ability of prehospital lactate levels to predict TBIs.…”

Association of initial lactate levels and red blood cell transfusion strategy with outcomes after severe trauma: a post hoc analysis of the RESTRIC trial

“…Multiple logistic regression models were used to estimate the adjusted odds ratio (OR) and their 95% CI for the occurrence of any organ failure within 7 days and any complications within 28 days. These analyses were conducted for each lactate level category and were adjusted for factors including age, sex, systolic blood pressure on ED arrival, the presence of a severe head injury [defined as an Abbreviated Injury Scale (AIS) of 4 or 5 for the head], injury severity score (ISS), initial hemoglobin levels, and the need for major hemostatic interventions based on the previous studies [ 11 , 13 ].…”

“…Cox regression analysis was utilized to estimate the hazard ratio (HR) and its 95% confidence interval (CI) for [11,13].…”

“…Extensive literature has demonstrated that initial lactate values are independently associated with in-hospital mortality or the need for massive transfusion [ 8 – 11 ]. Given these findings, we hypothesized that the optimal hemoglobin target could vary according to initial lactate levels; a higher hemoglobin target may be preferable for patients with elevated initial lactate levels, whereas a lower target may be more appropriate for those with normal lactate levels to avoid potential harm from excessive transfusion.…”

Avaliação dos desfechos neurológicos e mortalidade em doentes com trauma cranioencefálico grave submetidos ao protocolo de transfusão maciça

“…. O estudo de Park et al concluiu que o nível de lactato é um possível marcador prognóstico para PTM em trauma grave, entretanto não para as lesões cranianas associadas a transfusão liberal(PARK et al, 2019). Diferente disto, o presente estudo não encontrou significância em relação ao pior desfecho neurológico dos que sobreviveram ou dos que evoluíram a óbito e os marcadores de má perfusão tecidual.…”