Is there an association between body temperature and serum lactate levels in hip fracture patients?

Abstract

INTRODUCTION Hyperlactataemia is associated with adverse outcomes in trauma cases. It is thought to be the result of anaerobic respiration during hypoperfusion. This produces much less energy than complete aerobic glycolysis. Low body temperature in the injured patient carries an equally poor prognosis. Significant amounts of energy are expended in maintaining euthermia. Consequently, there may be a link between lactate levels and dysthermia. Hyperlactataemia may be indicative of inefficient energy production and therefore insufficient energy to maintain euthermia. Alternatively, significant amounts of available oxygen may be sequestered in thermoregulation, resulting in anaerobic respiration and lactate production.Our study investigated whether there is an association between lactate levels and admission body temperature in hip fracture patients. Furthermore, it looked at whether there is a difference in the mean lactate levels between hip fracture patients with low (<36.5°C), normal (36.5-37.5°C) and high (>37.5°C) body temperature on admission, and for patients who have low body temperature, whether there is a progressive rise in serum lactate levels as body temperature falls. METHODS The admission temperature and serum lactate of 1,162 patients presenting with hip fracture were recorded. Patients were divided into the euthermic (body temperature 36.5-37.5°C), the pyrexial (>37.5°C) and those with low body temperature (<36.5°C). Admission lactate and body temperature were compared. RESULTS There was a significant difference in age between the three body temperature groups (p=0.007). The pyrexial cohort was younger than the low body temperature group (mean: 78 vs 82 years). Those with low body temperature had a higher mean lactate level than the euthermic (2.2mmol/l vs 2.0mmol/l, p=0.03). However, there was no progressive rise in serum lactate level as admission temperature fell. CONCLUSIONS The findings suggest that in hip fracture patients, the body attempts initially to maintain euthermia, incurring an oxygen debt. This would explain the difference in lactate level between the low body temperature and euthermic cohorts. The fact that there is no correlation with the degree of temperature depression and lactate levels indicates that the body does not fuel thermohomeostasis indefinitely with oxygen. Instead, in part, it abandons thermoregulatory mechanisms. Consequently, in this population, active rewarming may be indicated rather than depending on patients' own thermogenic ability.

Brain Metabolomics Reveal the Antipyretic Effects of Jinxin Oral Liquid in Young Rats by Using Gas Chromatography–Mass Spectrometry

“…Glycolysis is a widespread phenomenon and is the basis of diverse brain activities. It is reported that more energy is required to maintain pyrexia [27], which has been proved by this experiment. From Figure 4 and Figure 5, we can easily find an increase in glycolysis in yeast-induced pyretic rat, which causes a reduced content in metabolites.…”

Too Cool? Hip Fracture Care and Maintaining Body Temperature

“…A large-scale multi-center retrospective cohort study by Faizi et al 13 stratified 1162 patients into groups based on body temperature (>37.5°C pyrexial, 36.5-37.5°C euthermic, <36.5°C low body temperature). Temperature data was taken via tympanic thermometers which were regularly calibrated by the units’ medical physics department.…”

“…There is a link between hypothermia and poor outcome—whist the studies reviewed are often contradictory of which outcome measure is most affected, they all demonstrate a negative association with periods of lower temperatures in the hip fracture population. Increasing serum lactate and its link to poor outcome, 13 unplanned admission and mortality are all demonstrated to be impacted by lower body temperatures. Interestingly, the literature supports a view that there is more than one opportunity for cooling to be reversed and opportunities to correct temperature control exist at all parts of the patient episode.…”

Survival at 30 days in elderly patients with hip fracture surgery who were exposed to hypothermia

“…[ 8 ] A reduction in core body temperature increases oxygen consumption and increases stress on cellular processes, resulting in high mortality. [ 9 ] Therefore, blood loss, peripheral vasoconstriction and decreased cardiac output, cause imbalance between the demand and supply of oxygen, especially in vital organs; and in the elderly with cardiovascular disease, heart failure and acute myocardial infarction may occur during postoperative hypothermia. [ 10 , 11 ] Despite heating protocols during the perioperative phases, there are several factors that cause hypothermia; such as, general anesthesia that inhibits the reflections of thermoregulation, the administration of intravenous fluids used to irrigate the wound, the temperature in the operating room; the nature, extent and duration of the surgical procedure, age over 60, low body weight, and American Society of Anesthesiologists (ASA) Classification.…”

“…Intraoperative hypothermia may decrease wound healing, increase the risk of surgical site infections (SSI) and increase intraoperative bleeding and cardiovascular morbidity [8] . A reduction in core body temperature increases oxygen consumption and increases stress on cellular processes, resulting in high mortality [9] . Therefore, blood loss, peripheral vasoconstriction and decreased cardiac output, cause imbalance between the demand and supply of oxygen, especially in vital organs; and in the elderly with cardiovascular disease, heart failure and acute myocardial infarction may occur during postoperative hypothermia [10,11] .…”