Lactate clearance as a predictor of mortality in trauma patients

Odom, Stephen R.; Howell, Michael D.; Silva, George S.; Nielsen, Victoria; Gupta, Alok; Shapiro, Nathan I.; Talmor, Daniel

doi:10.1097/ta.0b013e3182858a3e

Cited by 181 publications

(156 citation statements)

References 19 publications

Supporting

Mentioning

135

Contrasting

Unclassified

Order By: Relevance

“…Changes in lactate concentrations have been shown to provide an early and objective evaluation of a patient's response to therapy and repeated lactate determinations have proved to be a reliable prognostic index for patients with hemorrhagic shock. 20 Early return of lactate levels to normal levels (<2 mmol/l) within 24 h has been proved to be associated with improved outcomes in terms of mortality. A significant correlation has been established between the admission base deficit and transfusion requirements within the first 24 h and the risk of post-traumatic organ failure or death.…”

Section: Shock-hypoperfusionmentioning

confidence: 99%

The challenge in management of hemorrhagic shock in trauma

Jacob

Kumar

2014

Medical Journal Armed Forces India

View full text Add to dashboard Cite

a b s t r a c tTransfusion and resuscitation practices in trauma have undergone a sea change over the past decade. New understanding of transfusion physiology and experiences in military trauma over the last decade has identified key factors taken as challenges in trauma. The most important challenge remains acute traumatic coagulopathy (ATC) which sets in early after a trauma and spirals the patient into shock and continued bleeding. World wide trauma is the leading cause of mortality. More than 6 million deaths occur due to trauma out of which 20% are due to uncontrollable bleeding. Out of the hospital admissions in trauma 20% develop coagulopathy. Mortality is three to four times higher in a patient with coagulopathy and thus prevention and correction of coagulopathy is the central goal of the management of hemorrhagic shock in trauma. Damage control resuscitation (DCR), a strategy combining the techniques of permissive hypotension, hemostatic resuscitation and damage control surgery has been widely adopted as the preferred method of resuscitation in patients with haemorrhagic shock. The over-riding goals of DCR are to mitigate metabolic acidosis, hypothermia and coagulopathy, This article looks at the importance of acute traumatic coagulopathy, its etiology, diagnosis, effects and resuscitation strategies to prevent it and to see the background behind this shift.ª 2014, Armed Forces Medical Services (AFMS). All rights reserved.

show abstract

Section: Shock-hypoperfusionmentioning

confidence: 99%

The challenge in management of hemorrhagic shock in trauma

Jacob

Kumar

2014

Medical Journal Armed Forces India

View full text Add to dashboard Cite

show abstract

“…With regard to lactate, Odom et al reported admission lactate to be a potent predictor of mortality, independently of a host of confounders. 2 A lactate level of >4mmol/l increased the odds of death by a factor of 3.8, compared with those with a lactate level of <2.5mol/l. This was in spite of adjustment for age, injury severity score (ISS), Glasgow coma scale (GCS) score, heart rate and blood pressure.…”

mentioning

confidence: 99%

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

Murtuza

Farrier

Venkatesan

et al. 2015

annals

View full text Add to dashboard Cite

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.

show abstract

“…(18,19) They are also associated with mortality and morbidity in elderly with and without infections. (20) This study has additional limitations.…”

Section: Discussionmentioning

confidence: 99%

Predictors of neurological outcome in the emergency department for elderly patients following out-of-hospital restoration of spontaneous circulation

Nagata

Tsurukiri

Ueno

et al. 2015

View full text Add to dashboard Cite

Aims. Survival rates for cardiac arrest in acute medicine are higher following outof-hospital restoration of spontaneous circulation (OH-ROSC). However, data pertaining to OH-ROSC is limited in the elderly population. We aimed to assess the predictors of neurological outcome among elderly patients with OH-ROSC.Methods. We retrospectively analyzed the data of patients 65 years and older who achieved OH-ROSC and who presented to the emergency department (ED) between 2009 and 2013. The following parameters were considered: age, sex, medical history, vital signs, blood values, initial electrical rhythm, witnessed cardiac arrest, bystander cardiopulmonary resuscitation, resuscitation duration, attempted defibrillation, and neurological outcome. Neurological outcomes were evaluated 3 months after cardiac arrest, using the cerebral performance category (CPC) score, and were classified into two groups: favorable outcome (CPC = 1-2) and unfavorable outcome (CPC = 3-5).Results. Fifty-five patients were studied, of which 21 and 34 patients were classified as having favorable and unfavorable outcomes, respectively. The SIGNA VITAE 2015; 10(1): 53 -63 53 following values were associated with favorable outcomes: resuscitation duration, initial cardiac rhythm, base excess, pH, lactate levels, the motor response on the Glasgow Coma Scale (GCS), and the number of patients with GCS ≤8 (p < 0.01).Logistic regression analysis confirmed that motor response scores and lactate levels were independent predictors of neurological outcomes.Conclusions. Lactate levels and GCS motor response measured immediately at ED arrival are likely to be useful to assess the neurological outcomes among elderly patients with OH-ROSC.

show abstract

Lactate clearance as a predictor of mortality in trauma patients

Abstract: Prognostic study, level III.

Cited by 181 publications

References 19 publications

The challenge in management of hemorrhagic shock in trauma

The challenge in management of hemorrhagic shock in trauma

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

Predictors of neurological outcome in the emergency department for elderly patients following out-of-hospital restoration of spontaneous circulation

Contact Info

Product

Resources

About