The Effect of Ethanol on Lactate and Base Deficit as Predictors of Morbidity and Mortality in Trauma

Gustafson, Mark; Hollosi, Steve; Chumbe, Julton Tomanguillo; Samanta, Damayanti; Modak, Asmita; Bethea, Audis

doi:10.1016/j.ajem.2015.01.030

Cited by 44 publications

(31 citation statements)

References 18 publications

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“…One possible scenario might be that a trauma patient is found to have positive toxicology screenings upon admission. Substance abuse is frequently associated with the events resulting in a trauma and can often play an important role in the subsequent medical treatment of these patients 28. The patients were tested for ethanol in the blood.…”

Section: Discussionmentioning

confidence: 99%

Reduced butyrylcholinesterase activity is an early indicator of trauma-induced acute systemic inflammatory response

Zivkovic¹,

Bender²,

Brenner³

et al. 2016

JIR

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PurposeEarly diagnosis of systemic inflammatory response syndrome is fundamentally important for an effective and a goal-directed therapy. Various inflammation biomarkers have been used in clinical and experimental practice. However, a definitive diagnostic tool for an early detection of systemic inflammation remains to be identified. Acetylcholine (Ach) has been shown to play an important role in the inflammatory response. Serum cholinesterase (butyrylcholinesterase [BChE]) is the major Ach hydrolyzing enzyme in blood. The role of this enzyme during inflammation has not yet been fully understood. This study tests whether a reduction in the BChE activity could indicate the onset of the systemic inflammatory response upon traumatic injury.Patients and methodsThis observational study measured BChE activity in patients with traumatic injury admitted to the emergency room by using point-of-care-test system (POCT). In addition, the levels of routine inflammation biomarkers during the initial treatment period were measured. Injury Severity Score was used to assess the trauma severity.ResultsAltered BChE activity was correlated with trauma severity, resulting in systemic inflammation. Reduction in the BChE activity was detected significantly earlier compared to those of routinely measured inflammatory biomarkers.ConclusionThis study suggests that the BChE activity reduction might serve as an early indicator of acute systemic inflammation. Furthermore, BChE activity, measured using a POCT system, might play an important role in the early diagnosis of the trauma-induced systemic inflammation.

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Section: Discussionmentioning

confidence: 99%

Reduced butyrylcholinesterase activity is an early indicator of trauma-induced acute systemic inflammatory response

Zivkovic¹,

Bender²,

Brenner³

et al. 2016

JIR

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“…Plasma lactate concentration has been shown to have prognostic significance in human and veterinary patients. Hyperlactatemia has been associated with increased mortality in people in many clinical scenarios including trauma, infection, sepsis, and cardiac arrest . Hyperlactatemia has been associated with poor outcome in dogs with sepsis, gastric dilatation‐volvulus, systemic hypotension, and immune‐mediated hemolytic anemia .…”

Section: Introductionmentioning

confidence: 99%

“…Acid–base parameters including blood pH, base deficit (BD), and anion gap (AG) have also been associated with outcome in human ICU and emergency room patients . The association of acid–base parameters and outcome has not been well evaluated in small animal medicine.…”

Section: Introductionmentioning

confidence: 99%

Retrospective evaluation of the prognostic utility of plasma lactate concentration, base deficit, pH, and anion gap in canine and feline emergency patients

Kohen

Hopper

Kass

et al. 2017

J Vet Emergen Crit Care

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Objective -To determine the association of plasma lactate concentration, pH, base deficit (BD), and anion gap (AG) in dogs and cats on presentation to an emergency room with outcome, and to compare the prognostic significance of hyperlactatemia with a concurrent metabolic acidosis with that of hyperlactatemia and a normal metabolic acid-base balance. Design -Retrospective study. Setting -University teaching hospital. Animals -Five hundred sixty-six dogs and 185 cats that had venous blood gas analysis performed. Interventions -None. Measurements and Main Results -Medical records were reviewed for plasma lactate concentrations, electrolyte concentrations, and acid-base parameters obtained on emergency room admission, clinical diagnosis, and inhospital mortality. The primary outcome measure was all-cause mortality for the hospitalized visit. Median plasma lactate concentration and AG were higher, BD was more negative, and pH was lower, in non-survivor dogs and cats. The prevalence of hyperlactatemia was 53% in dogs and 30% in cats. Lactic acidosis was present in 42% and 80% of hyperlactatemic dogs and cats, respectively. Multivariate regression analyses revealed that plasma lactate concentration, BD, and pH, but not AG, were independent predictors of mortality in dogs, and that only plasma lactate concentration was an independent predictor of mortality in cats. Mortality was highest for animals with lactic acidosis, at 59.8% in dogs and 49% in cats. Mortality in dogs with lactic acidosis was significantly higher than dogs with hyperlactatemia and a normal acid-base status (P < 0.0001). Conclusions -The presence and magnitude of hyperlactatemia on presentation to the emergency room may help identify dogs and cats with high likelihood of in-hospital mortality, and the presence of lactic acidosis specifically may help identify dogs with yet higher risk of in-hospital mortality.

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“…Gustafson demonstrated that patients with +BAC had elevated lactate concentrations compared with controls on admission to the trauma centre (despite lower injury severity), fewer ICU days, and a shorter overall LOS compared with sober controls. In our cohort, the mortality rate among the +BAC patients was lower than that of the sober patients [28]. The +BAC patients were younger and had less severe injuries (33.9% had an ISS <9; 24.3% had an ISS >25).…”

Section: Discussionmentioning

confidence: 94%

“…Similar to previous studies, 42.8% of our injured patients had +BAC [8,14–17], demonstrating the continued need for clinicians to be aware of how to interpret biomarkers such as lactate in the context of common confounding comorbidities such as alcohol intoxication. A number of studies [8,28] sought to determine whether the predictive value of lactate levels measured on arrival changed in the context of acute alcohol ingestion. In this large study of injured patients with serial lactate measurements, those with +BAC exhibited a dose-dependent decrease in lactate clearance across a wide range of ages and injury severity.…”

Section: Discussionmentioning

confidence: 99%

Alcohol consumption decreases lactate clearance in acutely injured patients

Dezman

Comer

Narayan

et al. 2016

Injury

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Introduction Alcohol, a common risk factor for injury, has direct toxic effects on the liver. The use of lactate clearance has been well described as an indicator of the adequacy of resuscitation in injured patients. We investigated whether acutely injured patients with positive blood alcohol content (+BAC) had less lactate clearance than sober patients. Methods We conducted a retrospective cohort study of acutely injured patients treated at an urban Level 1 trauma centre between January 2010 and December 2012. Blood alcohol and venous lactate levels were measured on all patients at the time of arrival. Study subjects were patients transported directly from the scene of injury, who had an elevated lactate concentration on arrival (≥3.0 mmol/L) and at least one subsequent lactate measurement within 24 h after admission. Lactate clearance ([Lactate1 − Lactate2]/Lactate1) was calculated for all patients. Chi-squared tests were used to compare values from sober and intoxicated subjects. Lactate clearance was plotted against alcohol levels and stratified by age and Injury Severity Score (ISS). Results Serial lactate concentration measurements were obtained in 3910 patients; 1674 of them had +BAC. Patients with +BAC were younger (mean age: 36.6 [SD 14.7] vs 41.0 [SD 19.9] years [p = 0.0001]), were more often male (83.4% vs 75.9% [p = 0.0001]), had more minor injuries (ISS < 9) (33.8% vs 27.1% [p = 0.0001]), had a lower in-hospital mortality rate (1.4% vs 3.9% [p = 0.0001]), but also had lower average lactate clearance (37.8% vs 47.6% [p = 0.0001]). The lactate clearance of the sober patients (47.6 [SD 33.5]) was twice that of those with +BAC >400 (23.5 [SD 6.5]). Lactate clearance decreased with increasing BAC irrespective of age and ISS. Conclusions In a large group of acutely injured patients, a dose-dependent decrease in lactate clearance was seen in those with elevated BAC. This relationship will cause a falsely elevated lactate reading or prolong lactate clearance and should be taken into account when evaluating patients with +BAC.

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The Effect of Ethanol on Lactate and Base Deficit as Predictors of Morbidity and Mortality in Trauma

Cited by 44 publications

References 18 publications

Reduced butyrylcholinesterase activity is an early indicator of trauma-induced acute systemic inflammatory response

Reduced butyrylcholinesterase activity is an early indicator of trauma-induced acute systemic inflammatory response

Retrospective evaluation of the prognostic utility of plasma lactate concentration, base deficit, pH, and anion gap in canine and feline emergency patients

Alcohol consumption decreases lactate clearance in acutely injured patients

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