The Relationship of Serum Lactate and Base Deficit in Burn Patients to Mortality

Abstract

Serum lactate and base deficit in trauma patients have been shown to correlate with mortality. This study examines the relationship of these parameters to mortality among burn patients. We evaluated patients with >or=20% TBSA burn injury who had a serum lactate or base deficit recorded during the initial 48 hours of admission over a 5-year period. The primary study outcome was mortality. The mean (+/-SD) age of study patients (N = 128) was 35.2 +/- 21.1 years, the mean burn size was 41.7 +/- 17.9% TBSA, and the mortality rate was 17.1%. Mean serum lactate values of patients who died were significantly higher than those of survivors at admission and at 12, 18, and 24 hours after admission. The highest serum lactate value in the first 48 hours after admission was higher for nonsurvivors than survivors. Mean base deficit at admission and 6 hours after admission was significantly lower in patients who died than in survivors; in addition, the worst base deficit during the first 48 hours of care was significantly lower in patients who died than in those who survived. Early serum lactate and base deficit values are often worse for burn patients who die than for survivors. Elevation of serum lactate values during the first 48 hours after a burn is an independent risk factor for death, but no threshold value for serum lactate is demonstrable. Resuscitation should not be withheld from burn patients on the basis of any lactate or base deficit value.

Burn-induced muscle metabolic derangements and mitochondrial dysfunction are associated with activation of HIF-1α and mTORC1: Role of protein farnesylation

“…Hyperlactatemia is an independent risk factor for the mortality of burn patients 7 . Over and above hypoperfusion and subsequent tissue hypoxia, a metabolic shift from mitochondrial oxidative phosphorylation to ATP synthesis by glycolysis in the presence of sufficient oxygen availability has been proposed to contribute to hyperlactatemia in critical illnesses, such as sepsis and burn injury 9–13 .…”

Lactate clearance for death prediction in severe sepsis or septic shock patients during the first 24 hours in Intensive Care Unit: an observational study

“…In case of circulatory failure, such as severe sepsis, lactate concentration is a complex result of an anaerobic production, an aerobic production via the Na-K ATPase channel, and a decrease in lactate utilization [8-11]. However, several studies have described a correlation between baseline lactate concentration and mortality of ICU patients [12-15]. Although informative for severity assessment of septic patients, basal lactate rate is useless to guide therapy of such patients.…”

Early Acute Kidney Injury Predicts Progressive Renal Dysfunction and Higher Mortality in Severely Burned Adults

“…Cartotto et al19 have shown that a 24-hour BD < −6 was associated with a greater degree of systemic inflammatory response syndrome, ARDS, and MODS. Similarly, Cochran et al20 have shown BD and lactate values in the first 24 hours to be significantly worse in nonsurvivors. This is similar to other burn studies, which have shown elevated BDs to be associated with more extensive burns, inhalation injuries, higher than anticipated fluid requirements, and an increased risk of death 21–23.…”