Blood lactate concentration and shock index associated with massive transfusion in emergency department patients with primary postpartum haemorrhage

Sohn, Chang Hwan; Kim, Y.-J.; Seo, Dong Woo; Won, Hye‐Sung; Shim, Jae-Yoon; Lim, Kyung-Taek; Kim, W.Y.

doi:10.1016/j.bja.2018.04.039

Cited by 37 publications

(69 citation statements)

References 18 publications

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“…However, both studies included only women with PPH, with limited statistical analysis and fewer, less meaningful clinical outcomes. 14,27 Our research team previously performed two retrospective prediction studies to evaluate SI and conventional vital signs as predictors of adverse outcomes in women with PPH (high-and low-income settings) and to develop potential traffic light early-warning system thresholds for the CRADLE VSA. 12,13 The utility of SI in maternal sepsis has not previously been explored.…”

Section: Ta B L Ementioning

confidence: 99%

Shock index thresholds to predict adverse outcomes in maternal hemorrhage and sepsis: A prospective cohort study

Nathan

Seed

Hezelgrave

et al. 2019

Acta Obstet Gynecol Scand

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IntroductionShock index (SI) is a predictor of hemodynamic compromise in obstetric patients. The SI threshold for action is not well understood. We aimed to evaluate SI thresholds as predictors of outcomes in obstetric patients.Material and methodsWe undertook a prospective cohort study at three South African hospitals of women with postpartum hemorrhage (n = 283) or maternal sepsis (n = 126). The “first” and “worst” SI following diagnosis were recorded. SI was compared with conventional vital signs as predictors of outcomes. The performance of SI <.9, SI .9‐1.69 and SI ≥1.7 to predict outcomes (maternal death; Critical Care Unit admission; major procedure; hysterectomy) and hemorrhage‐specific outcomes (lowest hemoglobin <70 g/l; blood transfusion ≥4 IU) were evaluated.Results“First” SI was one of two best performing vital signs for every outcome in postpartum hemorrhage and sepsis. In hemorrhage, risk of all outcomes increased with increasing “first” SI; for blood transfusion ≥4 IU odds ratio was 4.24 (95% confidence interval 1.25‐14.36) for SI ≥1.7 vs SI .9‐1.69. In sepsis, risk of all outcomes increased with increasing “worst” SI. Sensitivity, specificity, positive and negative predictive values of “first” SI <.9 vs SI ≥.9 for maternal death were 100.0%, 55.2%, 4.6% and 100.0%, respectively, in hemorrhage and 80.0%, 50.4%, 12.3% and 96.7%, respectively, in sepsis.ConclusionsThe shock index was a consistent predictor of outcomes compared with conventional vital signs in postpartum hemorrhage and sepsis. SI <.9 performed well as a rule‐out test and SI .9‐1.69 and SI ≥1.7 indicated increased risk of all outcomes in both cohorts. These thresholds may alert to the need for urgent intervention and prevent maternal deaths.

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Section: Ta B L Ementioning

confidence: 99%

Shock index thresholds to predict adverse outcomes in maternal hemorrhage and sepsis: A prospective cohort study

Nathan

Seed

Hezelgrave

et al. 2019

Acta Obstet Gynecol Scand

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“…More blood transfusions were observed in the SPPH group compared to the non‐SPPH group, indicating that most of the patients with blood loss higher than 1500 mL may need a transfusion. Studies such as the one carried out by Lee et al, 27 Sohn et al, 28 and Hoskins and Berg 29 reported that a level of lactate higher than 4.0 mmol/L was associated with good specificity, sensitivity, and positive predictive value for massive transfusions in obstetric patients. Lactate from different samples such as the fetal scalp, amniotic fluid, and vaginal fluids has been used to detect fetal and maternal outcomes; however, none of them is applicable in cases of PPH due to the possible mixture of blood and other fluids during childbirth 30,31 …”

Section: Discussionmentioning

confidence: 96%

Early prognostic capacity of serum lactate for severe postpartum hemorrhage

Kway

Castillo-Reyther

Domínguez-Salgado

et al. 2020

Intl J Gynecology & Obste

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Objective To evaluate whether the concentration of serum lactate during the diagnosis of postpartum hemorrhage (bleeding ≥500 mL during labor or ≥1000 mL during cesarean delivery) predicts severe hemorrhage (SPPH; blood loss ≥1500 mL at end of labor or in the following 24 h). Methods A prospective cohort pilot study was conducted of women with a vaginal or cesarean delivery from February 2018 to March 2019 who presented with bleeding ≥500 mL measured by the gravimetric method in a reference hospital in San Luis Potosi, Mexico. Venous blood samples were taken for analysis of serum lactate. A receiver operating characteristic curve determined the serum lactate threshold value for SPPH and χ2 test assessed the difference in serum lactate elevation between SPPH and non‐SPPH groups. Lastly, the prognostic capacity between the thresholds was compared. Results SPPH developed in 43.33% of the 30 women in the study group. The best prognostic threshold was 2.68 mmol/L of serum lactate (odds ratio [OR] 17.88, 95% confidence interval [CI] 2.7–16.8, P < 0.001); sensitivity was 0.85 (95% CI 0.55–0.98); specificity was 0.76 (95% CI 0.50–0.93). Conclusion Serum lactate may be a useful prognostic marker for SPPH, more studies are needed to validate these findings.

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“…Another possible explanation for the inter-study discrepancy may be that septic shock in our patients was defined in accordance with the Sepsis-3 definition; thus, it included septic shock patients with more severe conditions and worse outcomes than those included in prior studies using outdated definitions of septic shock [27,28]. SI, calculated as HR divided by SBP, has been associated with early recognition and mortality of septic and hypovolemic shock [29][30][31][32]. In this study, however, the SIs in the patients with septic shock did not have a significant impact on survival outcomes.…”

Section: Discussionmentioning

confidence: 99%

Pulse pressure during the initial resuscitative period in patients with septic shock treated with a protocol-driven resuscitation bundle therapy

Lee

Kim

et al. 2020

Korean J Intern Med

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Background/Aims: Maintaining a mean arterial pressure (MAP) ≥ 65 mmHg during septic shock should be based on individual circumstances, but specific target is poorly understood. We investigated associations between time-weighted average (TWA) hemodynamic parameters during the initial resuscitative period and 28-day mortality. Methods: Prospectively collected data were obtained from a septic shock patient registry, according to the Sepsis-3 definition, between 2016 and 2018. The TWA systolic blood pressure, diastolic blood pressure, MAP, shock index, and pulse pressure (PP) during the first 6 hours after shock recognition were compared. Multivariable regression analysis was performed to assess associations between these parameters and 28-day mortality. Results: Of 340 patients with septic shock, 92 died. Only the median TWA PP differed between the survivors and non-survivors (39.2 mmHg vs. 43.0 mmHg, p = 0.020), whereas the other indexes did not. When PP was divided into quartiles (< 34, 34 to 40, 40 to 48, and > 48 mmHg), the mortality rate was higher in the highest quartile (41.2%). Multivariable logistic analysis revealed that PP (odds ratio [OR], 1.28; 95% confidence interval [CI], 1.012 to 1.622; p = 0.039) and PP of > 48 mmHg (OR, 2.25; 95% CI, 1.272 to 3.981; p = 0.005) were independently associated with 28day mortality. Conclusions: PP was significantly associated with 28-day mortality in patients with septic shock and MAP maintained at > 65 mmHg during the first 6 hours. Further studies are warranted to optimize strategies for maintaining PP and MAP at > 65 mmHg during the early resuscitative period.

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Blood lactate concentration and shock index associated with massive transfusion in emergency department patients with primary postpartum haemorrhage

Cited by 37 publications

References 18 publications

Shock index thresholds to predict adverse outcomes in maternal hemorrhage and sepsis: A prospective cohort study

Shock index thresholds to predict adverse outcomes in maternal hemorrhage and sepsis: A prospective cohort study

Early prognostic capacity of serum lactate for severe postpartum hemorrhage

Pulse pressure during the initial resuscitative period in patients with septic shock treated with a protocol-driven resuscitation bundle therapy

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