Lactate as Predictor of Mortality in Polytrauma

Freitas, Andréia Diane; Franzon, Orli

doi:10.1590/s0102-67202015000300004

Cited by 40 publications

(32 citation statements)

References 14 publications

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“… Heinonen, 2014 [ 51 ] 610 Retrospective – Variable Variable Failure to normalize lactate associated with increased mortality 35. Freitas, 2015 [ 52 ] 117 Retrospective – 6 h 6 h No correlation between decrease in lactate and mortality 36. Dezman, 2015 [ 53 ] 3887 Retrospective ≥3 Variable Variable No decrease in lactate independent predictor of 24-h mortality Interventional 37.…”

Section: Resultsmentioning

confidence: 99%

“…We identified twelve observational studies in trauma patients [ 42 – 53 ]. Three retrospective studies reported no association of change in lactate levels with mortality [ 43 , 47 , 52 ], although Manikis et al [ 43 ] reported that the duration of hyperlactatemia was associated with the development of organ failure and Billeter et al [ 47 ] noted that delayed or no reduction in blood lactate was associated with increased infectious complications. Several small studies used relatively long time intervals of 12–24 hrs [ 45 , 54 ].…”

Section: Resultsmentioning

confidence: 99%

“…This observation was similar across all studies and in all categories of patients, without being restricted to those with sepsis. We found only one study which suggested that evaluating the time course of lactate concentrations would be useful in sepsis patients but not in other conditions [ 26 ], and just five studies reporting no predictive effect of decrease in lactate levels over time on mortality [ 43 , 47 , 52 , 88 , 101 ] although two of these did suggest a relationship with morbidity outcomes [ 43 , 47 ]. Repeated lactate concentrations can also help separate patients with complications, such as neurological complications after cardiac arrest [ 112 , 113 ] or after surgery [ 38 ].…”

Section: Discussionmentioning

confidence: 99%

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The value of blood lactate kinetics in critically ill patients: a systematic review

et al. 2016

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BackgroundThe time course of blood lactate levels could be helpful to assess a patient’s response to therapy. Although the focus of published studies has been largely on septic patients, many other studies have reported serial blood lactate levels in different groups of acutely ill patients.MethodsWe performed a systematic search of PubMed, Science Direct, and Embase until the end of February 2016 plus reference lists of relevant publications. We selected all observational and interventional studies that evaluated the capacity of serial blood lactate concentrations to predict outcome. There was no restriction based on language. We excluded studies in pediatric populations, experimental studies, and studies that did not report changes in lactate values or all-cause mortality rates. We separated studies according to the type of patients included. We collected data on the number of patients, timing of lactate measurements, minimum lactate level needed for inclusion if present, and suggested time interval for predictive use.ResultsA total of 96 studies met our criteria: 14 in general ICU populations, five in general surgical ICU populations, five in patients post cardiac surgery, 14 in trauma patients, 39 in patients with sepsis, four in patients with cardiogenic shock, eight in patients after cardiac arrest, three in patients with respiratory failure, and four in other conditions. A decrease in lactate levels over time was consistently associated with lower mortality rates in all subgroups of patients. Most studies reported changes over 6, 12 or 24 hrs, fewer used shorter time intervals. Lactate kinetics did not appear very different in patients with sepsis and other types of patients. A few studies suggested that therapy could be guided by these measurements.ConclusionsThe observation of a better outcome associated with decreasing blood lactate concentrations was consistent throughout the clinical studies, and was not limited to septic patients. In all groups, the changes are relatively slow, so that lactate measurements every 1–2 hrs are probably sufficient in most acute conditions. The value of lactate kinetics appears to be valid regardless of the initial value.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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The value of blood lactate kinetics in critically ill patients: a systematic review

et al. 2016

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“…Lactate value > 4 mmol/l is rare, and is associated with systemic inflammation and needs ICU care. 25,26 In 2013, 4742 trauma patients were included in their analysis by Stephen R. Odom, who concluded that lactate values <4 mEq/l were the best death predictors in trauma patients 14 . Unlike previous research in 2015, Freitas and Franzon found that in patients treated with multiple traumas there is no association between lactate admission and mortality 25 .…”

Section: Discussionmentioning

confidence: 99%

Evaluation of Lactate and Lactate Clearance as a Marker of Outcome in Trauma ICU

Mishra

Hakim

Mishra

et al. 2020

Asian Journal of Pharmaceutical Research and Health Care

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Hypo-perfusion is usual in patients suffering from traumatic injury that may be indicated by serum lactate elevation. This study was performed to analyze the relation of the lactate value with trauma mortality and its clearance. The research included a total of 202 trauma patients admitted into ICU. Study parameters such as patient demography, injury mechanism, Blood Pressure (BP), heart rate (HR), Glasgow Coma Scale (GCS) and level of lactate in the blood. All these parameters were documented in the first 3 hours of hospitalization, and lactate clearance was recorded between 3 and 9 hours afterwards. For the study point; death up to 7 days was considered as a direct impact of trauma and considered in study. The study was divided into two subgroups, either expired (n=79) or survivors (n=123) according to the final outcome. The mean age, mean body weight, sex ratio, HR, Systolic Blood Pressure (SBP) and Diastolic Blood Pressure (DBP) in both groups were comparable. The difference in lactate at admission, lactate at 6 hours and lactate clearance in between survivors and deaths were found to be insignificant statistically. Among trauma patients there is no significant relationship between lactate admission or lactate clearance and mortality. Higher sample size may be appropriate for definitive proof to be reached.

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“…Our results are consistent with those reported by Mikkelsen et al ( 23 ). In spite of prevailing evidence that the lactate reduction influences the critically ill patient outcomes, there are five studies reporting no predictive effect of a decrease in lactate levels over time on mortality ( 24 , 25 , 26 , 27 , 28 ). Although they showed no effect on mortality, the study by Manikis et al ( 24 ) and Billeteret al ( 25 ) suggested a relationship between lactate concentration and morbidity outcomes.…”

Section: Discussionmentioning

confidence: 99%

Hyperlactatemia and the Importance of Repeated Lactate Measurements in Critically Ill Patients

Godinjak

Jusufović

Rama³

et al. 2017

Med Arch

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ObjectiveThe aim of the study was to describe the prevalence of hyperlactatemia and emphasis on repeated lactate measurements in critically ill patients, and the associated mortality.Materials and methodsThe study included 70 patients admitted in the Medical Intensive Care Unit at the Clinical Center, University of Sarajevo, in a 6-month period (July - December 2015). The following data were obtained: age, gender, reason for admission, Simplified Acute Physiology Score II, Acute Physiology and Chronic Health Evaluation, lactate concentrations upon admission, after 24 and 48 hours, and outcome (discharge from hospital or death).ResultsUpon admission,hyperlactatemia was present in 91.4% patients with a mean concentration of lactate 4.13 ±1.21 mmol/L. Lactate concentration at 48 hours was independently associated within creased in-hospital mortality (P = 0.018).ConclusionPersistent hyperlactatemia is associated with adverse outcome in critically ill patients. Lactate concentration at 48 hours is independently associated within creased in-hospital mortality and it represents a statistically significant predictive marker of fatal outcomes of patients. Blood lactate concentrations > 2.25 mmol/L should be used by clinicians to identify patients at higher risk of death.

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Lactate as Predictor of Mortality in Polytrauma

Cited by 40 publications

References 14 publications

The value of blood lactate kinetics in critically ill patients: a systematic review

The value of blood lactate kinetics in critically ill patients: a systematic review

Evaluation of Lactate and Lactate Clearance as a Marker of Outcome in Trauma ICU

Hyperlactatemia and the Importance of Repeated Lactate Measurements in Critically Ill Patients

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