The predictive value of serum lactate to forecast injury severity in trauma-patients increases taking age into account

Hagebusch, Paul; Faul, Philipp; Ruckes, Christian; Störmann, Philipp; Marzi, Ingo; Hoffmann, Reinhard; Schweigkofler, Uwe; Gramlich, Yves

doi:10.1007/s00068-022-02046-2

Cited by 3 publications

(4 citation statements)

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“…1. Ninety-one percent of injuries (n = 213) were caused by a blunt mechanism and median Injury Severity Score (ISS) was 33 (24)(25)(26)(27)(28)(29)(30)(31)(32)(33)(34)(35)(36)(37)(38) with most severe injuries located in the brain (AIS head 3 (0-4)) and chest (AIS chest 3 (2-4)). Physiology, resuscitation, and outcome data are presented in Table 1.…”

Section: Resultsmentioning

confidence: 99%

“…This could be expected since elderly patients have less physiological reserve and are more likely to be coagulopathic based on the medication they frequently use. Others have described the influence of age on mortality as well [29][30][31]. Further, patients who later died were more severely injured to the brain and chest, and had a more severe respiratory acidosis on arrival in ED even though there was no difference in prehospital intubation rate.…”

Section: Discussionmentioning

confidence: 99%

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Early correction of base deficit decreases late mortality in polytrauma

Wessem

Hietbrink

Leenen

2022

Eur J Trauma Emerg Surg

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Introduction Physiology-driven resuscitation has become the standard of care in severely injured patients. This has resulted in a decrease in acute deaths by hemorrhagic shock. With increased survival from hemorrhage, focus shifts towards death later during hospital stay. This population based cohort study investigated the association of initial physiology derangement correction and (late) mortality. Methods Consecutive polytrauma patients aged > 15 years with deranged physiology who were admitted to a level-1 trauma center intensive care unit (ICU) from 2015 to 2021, and requiring surgical intervention < 24 h were included. Patients who acutely (< 48 h) died were excluded. Demographics, treatment, and outcome parameters were analyzed. Physiology was monitored by serial base deficits (BD) during the first 48 h. Correction of physiology was defined as BD return to normal values. Area under the curve (AUC) of BD in time was used as measurement for the correction of physiological derangement and related to mortality 3–6 days (early), and > 7 days (late). Results Two hundred thirty-five patients were included with a median age of 44 years (70% male), and Injury Severity Score (ISS) of 33. Mortality rate was 16% (71% due to traumatic brain injury (TBI)). Median time to death was 11 (6–17) days; 71% died > 7 days after injury. There was no difference between the single base deficit measurements in the emergency department(ED), operating room (OR), nor ICU between patients who died and those who did not. However, patients who later died were more acidotic at 24 and 48 h after arrival, and had a higher AUC of BD in time. This was independent of time and cause of death. Conclusion Early physiological restoration based on serial BD measurements in the first 48 h after injury decreases late mortality.

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Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Early correction of base deficit decreases late mortality in polytrauma

Wessem

Hietbrink

Leenen

2022

Eur J Trauma Emerg Surg

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“…As shock is a marker of poor tissue production, EL level is a widely accepted surrogate marker of shock and is used to guide resuscitation [8,15,16]. A recent publication in the trauma literature describes the utility of age-adapted lactate values to improve the predictive value in older patients [17].…”

Section: Discussionmentioning

confidence: 99%

Combination of Lactate and Base Deficit Levels at Admission to Predict Mortality in Blunt Trauma Patients

Ward¹,

Olafson²,

Cohen³

et al. 2023

Cureus

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Introduction: Elevated lactate levels are associated with increased mortality in both trauma and non-trauma patients. The relation between base deficit (BD) and mortality is less clear. Traumatologists debate the utility of elevated lactate (EL) versus BD in predicting mortality. We hypothesized that EL (2mmol/L to 5mmol/L) and BD (≤−2mmol/L) in combination could predict mortality in blunt trauma patients.Methods: This is a retrospective analysis of the trauma registry from 2012 to 2021 at a level 1 trauma center. Blunt trauma patients with admission lactate and BD values were included in the analysis. Exclusion criteria were age <18, penetrating trauma, unknown mortality, and unknown lactate or BD. Logistics regression of the total 5153 charts showed 93% of the patients presented with lactate levels <5mmol/L, therefore patients with lactate >5mmol/L were excluded as outliers. The primary outcome was mortality.Results: A total of 4794 patients (151 non-survivors) were included in the analysis. Non-survivors had higher rates of EL + BD (35.8% vs. 14.4%, p <0.001). When comparing survivors and non-survivors, EL + BD (OR 5.69), age >65 (5.17), injury severity score (ISS) >25 (8.87), Glasgow coma scale <8 (8.51), systolic blood pressure (SBP) <90 (4.2), and ICU admission (2.61) were significant predictors of mortality. Other than GCS <8 and ISS >25, EL + BD had the highest odds of predicting mortality. Conclusion: Elevated lactate + BD on admission in combination represents a 5.6-fold increase in mortality in blunt trauma patients and can be used to predict a patient's outcome on admission. This combination variable provides an additional early data point to identify patients at elevated risk of mortality at the moment of admission.

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“…It is apparent that the existing triage protocols often do not identify the polytraumatized patient with sufficient accuracy. In their retrospective analysis, Hagebusch et al [3] determined serum lactate levels in patients in whom TTA was performed solely due to the mechanism of trauma. They were able to show that lactate levels, especially in older patients, are very suitable for identifying patients with an ISS > 15 and suggest that lactate should be included in triage algorithms to reduce undertriage.…”

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confidence: 99%