Comparison of Lactate Clearance with Established Risk Assessment Tools in Predicting Outcomes in Acute Upper Gastrointestinal Bleeding

Abstract

Early risk stratification is mandatory in acute upper gastrointestinal bleeding (AUGIB) to guide optimal treatment. Numerous risk scores were introduced, but lack of practicability led to limited use in daily clinical practice. Lactate clearance is an established risk assessment tool in a variety of diseases, such as trauma and sepsis. Therefore, this study compares the predictive ability of pre-endoscopic lactate clearance and established risk scores in patients with AUGIB at the University Hospital of Cologne. Active bleeding was detected in 27 (25.2%) patients, and hemostatic intervention was performed in 35 (32.7%). In total, 16 patients (15%) experienced rebleeding and 12 (11.2%) died. Initially, lactate levels were elevated in 64 cases (59.8%), and the median lactate clearance was 18.7% (2.7–48.2%). Regarding the need for endoscopic intervention, the predictive ability of Glasgow Blatchford Score, pre-endoscopic Rockall score, initial lactate and lactate clearance did not differ significantly, and their area under the receiver operating characteristic curves were 0.658 (0.560–0.747), 0.572 (0.473–0.667), 0.572 (0.473–0.667) and 0.583 (0.483–0.677), respectively. Similar results were observed in relation to rebleeding and mortality. In conclusion, lactate clearance had comparable predictive ability compared to established risk scores. Further prospective research is necessary to clarify the potential role of lactate clearance as a reliable risk assessment tool in AUGIB.

Lactate Levels and Clearance: Key Predictors of Prognosis for COVID-19 and Non-COVID-19 Septic Shock Patients in the Emergency Department

“…Shankar-Hari et al (2016) highlight the nuanced understanding of sepsis definitions and clinical criteria, suggesting the need for continued refinement in diagnostic and treatment strategies to address septic shock more effectively [ 36 ]. Furthermore, Allo et al (2023) demonstrate the potential of lactate clearance as a predictive tool in acute conditions like upper gastrointestinal bleeding, indicating the broader applicability of lactate metrics in critical care settings [ 37 ]. These insights pave the way for innovative therapeutic interventions aimed at enhancing lactate clearance, potentially improving outcomes in septic shock patients.…”