Comparison of base excess, lactate and pH predicting 72-h mortality of multiple trauma

Abstract

Objective To compare the predictive values of base excess (BE), lactate and pH of admission arterial blood gas for 72-h mortality in patients with multiple trauma. Methods This was a secondary analysis based on a publicly shared trauma dataset from the Dryad database, which provided the clinical data of 3669 multiple trauma patients with ISS > = 16. The records of BE, lactate, pH and 72-h prognosis data without missing values were selected from this dataset and 2441 individuals were enrolled in the study. Logistic regression model was performed to calculate the odds ratios (ORs) of variables. Area under the curve (AUC) of receiver operating curve (ROC) was utilized to evaluate the predictive value of predictors for 72 h in-hospital mortality. Pairwise comparison of AUCs was performed using the Delong’s test. Results The statistically significant correlations were observed between BE and lactate (r = − 0.5861, p < 0.05), lactate and pH (r = − 0.5039, p < 0.05), and BE and pH (r = − 0.7433, p < 0.05). The adjusted ORs of BE, lactate and pH for 72-h mortality with the adjustment for factors including gender, age, ISS category were 0.872 (95%CI: 0.854–0.890), 1.353 (95%CI: 1.296–1.413) and 0.007 (95%CI: 0.003–0.016), respectively. The AUCs of BE, lactate and pH were 0.693 (95%CI: 0.675–0.712), 0.715 (95%CI: 0.697–0.733), 0.670 (95%CI: 0.651–0.689), respectively. Conclusions There are significant correlations between BE, lactate and pH of the admission blood gas, all of them are independent predictors of 72-h mortality for multiple trauma. Lactate may have the best predictive value, followed by BE, and finally pH.

Routine laboratory parameters predict intensive care unit admission and hospitalization in patients suffering stab injuries

“…Prehospital lactate levels were previously shown to predict resuscitative care in trauma patients and may be used to aid triage of normotensive trauma patients ( 59 ). High lactate and low pH additionally predicted 72 h mortality in multiple trauma patients ( 60 ). Coherently, we identified increased lactate and low pH levels at admission as predictors of ICU admission in penetrating and thoracoabdominal injury patients following stabbing trauma.…”

Biochemical disturbance in damage control resuscitation: mechanisms, management and prognostic utility

“…Although this is applicable to intensivists, it is less so to trauma anaesthesiologists managing DCR. The predictive values of admission base excess, lactate and pH on 72 h mortality have been assessed [23 ▪ ]. Although area under the receiver operator curve (AUROC) values suggested lactate's superiority, pH's specificity was higher (87 versus 72%) and in decisions on resuscitation termination, accurate identification of true positives is more important than avoidance of false negatives.…”

Variables fisiológicas del “componente metabólico” del estado ácido base y mortalidad en pacientes de cuidados intensivos

“…Otra variable ampliamente estudiada como predictora de mortalidad en diferentes escenarios clínicos es la BE. Algunos estudios han reportado relación de la BE con los resultados clínicos adversos incluyendo la mortalidad, en poblaciones específicas de pacientes críticos (17,18), especialmente en pacientes con trauma (19)(20)(21), sin embargo, un estudio Realizado por Masevicius et al (22), en una UCI médico-quirúrgica donde recolectaron 4901 pacientes durante 9 años, no mostró asociación de la BE con la mortalidad hospitalaria (22). En el presente estudio la BEst no mostró significancia estadística en el análisis bivariado.…”