Study of initial blood lactate and delta lactate as early predictor of morbidity and mortality in trauma patients

Figures & data

Table 1. Characteristics Of trauma Patients.

	N = 519	Missing data (N)
Men	409(79.1%)	0
Age, years	42 ± 20	0
Mechanism of trauma		0
Fall	104(20%)
Road Crash	326(63%)
Gunshot	23(4%)
Stab wound	27(5%)
Other	39(8%)
Origin of patient		3
Primary	392(76%)
Secondary	84(16%)
Emergency room	40(8%)
Pre-hospital phase
Systolic arterial blood pressure min, mmHg	105±36	81
Heart rate max, Beats/min	98±28	83
Glasgow Coma score	14(8–15)	0
Peripheral Oxygen saturation min, %	97(91–100)	23
Cardiac arrest	20(4%)	0
Catecholamine administration	70(14%)	14
Mechanical ventilation	162(32%)	7
Time taken to reach the scene, minutes	17±11	181
Time taken to reach the hospital, minutes	59±58	158
ASA1	1(1–2)	0
Initial lactate	2.89 ± 3.20	102
Lactates at 2 hrs	3.69 ± 3.71	427
Lactates during first 24 hrs	2.05 ± 1.75	300
Hospital phase
Systolic arterial pressure, mmHg	123±29	31
Heart rate, beats/min	89±23	30
Hemoglobin, g/dl	12.63±2.22	19
Blood alcohol level, g/dl	0.32±0.72	0
Results of FAST		95
Positive	102(24%)
Open fracture	84(17%)	21
Surgery or interventionnel direct	23(4%)	135
Emergency procedure	226(44%)	0
Neurosurgery	53(10%)	0
Orthopedic surgery	108(21%)	0
Thoracic surgery	11(2%)	0
Visceral surgery	41(8%)	0
Radiologic intervention	20(4%)	0
Vascular surgery	20(4%)	0
Other surgery	17(3%)	0
Massive hemorrhage2	54(10%)	0
Cranial trauma	178(34%)	0
Duration of stay in the ICU, days	3(2–6)	1
Duration of stay in the hospital, days	9(5–17)	91
Death	61(12%)	0
Cause of death:
Brain death	19(31%)
Cranial trauma	15(25%)
Hemorrhagic shock	4(7%)
Limitation of life sustaining treatment	9(15%)
Multiple organ failure	9(15%)
Others	5(8%)
SAPS II3	32(21–49)	0
SOFA4	3(0–6)	87
ISS5	16(9–25)	118
RTS6	7.84(5.97–7.84)	115
TRISS7	0.03(0.01–0.15)	200
Normalization of lactate	392(76%)	1

1, American Society of Anesthesia, 2, transfusion of more than or equal to 4 PRBCs within 6 hours, 3, Simplified Acute Physiology Score, 4, Sequential Organ Failure assessment, 5, Injury Severity Score, 6, Revised Trauma Score, 7, Trauma Related Injury Severity Score

Table 2. Comparison of Patients who survived or not.

N = 519	Dead (n = 61)	Alive (n = 458)	P value
Men	43 (11%)	366 (89%)	NS
Age, yr	52±22	40±19	<0.05
Mechanism of trauma			<0.05
Fall	21(35%)	83(18%)
Road Crash	35(58%)	291(63%)
Gunshot	2(3%)	21(5%)
Stab wound	0	27(6%)
Other	3(4%)	36(8%)
Origin of patient			NS
Primary	47(77%)	345(76%)
Secondary	12(20%)	72(16%)
Emergency room	2(3%)	38(8%)
Pre-hospital phase
Systolic arterial blood pressure min, mmHg	72 ± 63	110±27	<0.05
Heart rate max, Beats/min	86 ± 48	100 ± 25	<0.05
Glasgow Coma score	3(3–8)	15(12–15)	<0.05
Peripheral Oxygen saturation min, %	90(80–98)	97(92–100)	<0.05
Cardiac arrest	19 (31%)	1 (0.2%)	<0.05
Catecholamine administration	32(54%)	38(9%)	<0.05
Mechanical ventilation	51(85%)	111(25%)	<0.05
Time taken to reach the scene, minutes	15(10–20)	15(10–20)	NS
Time taken to reach the hospital, minutes	52(30–84)	45(25–77)	NS
ASA	2(1–3)	1(1–2)	<0.05
Hospital phase
Systolic arterial pressure, mmHg	106 ± 50	125 ± 24	<0.05
Heart rate, beats/min	84 ± 39	90 ± 21	<0.05
Hemoglobin, g/dl	10.69 ± 2.62	12.88 ± 2.04	<0.05
Blood alcohol level, g/dl	0.28 ± 0.72	0.32 ± 0.72	NS
PH	7.16 ± 0.23	7.35 ± 0.10	<0.05
FAST results			NS
Negative	33(70%)	289(77%)
Positive	14(30%)	88(23%)
Open fracture	9 (16%)	75 (17%)	NS
Surgery or interventional direct	5(11%)	18(5%)	NS
Emergency procedure	22(36%)	204(45%)	NS
Neurosurgery	11 (18%)	42 (9%)	0.05
Orthopedic surgery	2 (3%)	106 (23%)	<0.05
Thoracic surgery	1 (2%)	10 (2%)	NS
Visceral surgery	8 (13%)	33 (7%)	NS
Radiologic intervention	5 (8%)	15 (3%)	NS
Vascular surgery	1 (2%)	19 (4%)	NS
Other surgery	0 (0%)	9 (2%)	NS
Massive hemorrhage	16 (26%)	38 (8%)	<0.05
Cranial trauma	45 (74%)	133 (29%)	<0.05
Duration of stay in the ICU, days	2 (2–7)	3 (2–6)	<0.05
Duration of stay in the hospital, days	2(2–7)	10(6–19)	<0.05
SAPS II	30(19–46)	40.5 (28.25–60.75)	<0.05
SOFA	10 (8–11)	2 (0–5)	<0.05
ISS	26(25–41)	16(9–22)	<0.05
RTS	4.09 (1.16–5.03)	7.84 (6.38–7.84)	<0.05
TRISS	0.73 (0.37–0.87)	0.02 (0.01–0.09)	<0.05
Normalization of lactate in 24 hr	37(61%)	355(78%)	<0.05

Table 3. Comparison of patients with normalization of lactate or not in the 24 first hours.

N = 518	Normalization of lactate (n = 392)	Non normalization of lactate (n = 126)	P value
Men	321 (79%)	87 (21%)	<0.05
Age, yr	42 ± 20	40±18	NS
Mechanism of trauma			NS
Fall	82	22
Road Crash	239	87
Gunshot	17	6
Stab wound	25	2
Other	30	9
Origin of patient			NS
Primary	288(74%)	103(26%)
Secondary	65(77%)	19(23%)
Emergency room	37(93%)	3(7%)
Pre-hospital phase
Systolic arterial blood pressure min, mmHg	107 ± 34	96 ± 40	<0.05
Heart rate max, Beats/min	98 ± 26	100 ± 34	NS
Glasgow Coma score	15(10–15)	13(6–15)	<0.05
Peripheral Oxygen saturation min, %	97(92–100)	96(88–100)	<0.05
Cardiac arrest	11 (3%)	9 (7%)	0.05
Catecholamine administration	43(11%)	27(22%)	<0.05
Mechanical ventilation	110(29%)	52(42%)	<0.05
Time taken to reach the scene, minutes	15(10–20)	15(10–20)	NS
Time taken to reach the hospital, minutes	45(24–80)	45(25–77)	<0.05
ASA	1(1–2)	1(1–2)	<0.05
Hospital phase
Systolic arterial pressure, mmHg	124 ± 29	119 ± 29	NS
Heart rate, beats/min	88 ± 23	93 ± 26	<0.05
Hemoglobin, g/dl	12.86 ± 2.11	11.93 ± 2.42	<0.05
Blood alcohol level, g/dl	0.23 ± 0.60	0.57 ± 0.95	<0.05
FAST results			NS
Negative	238(77%)	83(72%)
Positive	70(23%)	32(28%)
Open fracture	56 (15%)	28 (23%)	NS
Surgery or interventional direct	14(5%)	9(9%)	NS
Emergency procedure	149(38%)	77(61%)	<0.05
Neurosurgery	36 (9%)	17(13%)	NS
Orthopedic surgery	74(19%)	34 (27%)	NS
Thoracic surgery	7 (2%)	4 (3%)	NS
Visceral surgery	19(5%)	22(17%)	<0.05
Radiologic intervention	9 (2%)	11(9%)	<0.05
Vascular surgery	9(2%)	11(9%)	<0.05
Other surgery	5(1%)	4(3%)	NS
Massive hemorrhage	25 (6%)	29(23%)	<0.05
Cranial trauma	127 (32%)	51 (40%)	NS
Duration of stay in the ICU, days	3 (2–6)	5 (3–8)	<0.05
Duration of stay in the hospital, days	9(4–16)	11(5–22)	<0.05
Causes of death			<0.05
Brain death	7(19%)	12(50%)
Cranial trauma	12(32%)	3(13%)
Hemorrhagic shock	1(3%)	3(13%)
Limitation of life sustaining treatment	7(19%)	2(8%)
Multiple organ failure	7(19%)	2(8%)
Other	3(8%)	2(8%)
SAPS II	30(19–46)	40.5 (28.25–60.75)	<0.05
SOFA	2 (0–5)	5 (2–8)	<0.05
ISS	16(9–25)	18(9–26.5)	<0.05
RTS	7.84 (5.97–7.84)	6.38 (5–7.84)	<0.05
TRISS	0.03 (0.01–0.12)	0.05 (0.01–0.32)	<0.05
Death	37(61%)	24(39%)	<0.05

Table 4. Multivariate analysis: factors associated with mortality.

Variables	OR	95%CI	p
normalization of lactate	1,8	0,5–8,0	0.4
Sex (M)	0,2	0,03–1,1	0.07
GCS initial (>9)	0.8*	0.61–0.96	0.04
Cardiorespiratory arrest pre hospital	62*	2.2–4400	0.03
Systolic arterial blood pressure min	1,0	1,0–1,1	0.5
Diastolic arterial blood pressure min	1,0	0,9–1,1	0.8
Hemoglobin	0,8	0,5–1,1	0.1
Catecholamine	0,7	0,1–4,4	0.7
Mechanical ventilation	2,6	0,2–35	0.4
PH>7,37	0.0028*	0.00066–0.52	0.04
platelets	1,0	1,0–1,0	0.05
Fibrinogen >2 g/dL	0,4	0,1–0,9	0.06
Emergency procedure	0,1	0,05–3,0	0.2

Multivariate analysis with the different factors chosen in the analysis. *: independent association with mortality. OR: Odd Ratio. 95 CI: 95% confidence Interval

Table 5. Multivariate analysis: factors associated with normalization of lactate.

Variables	OR	95%CI	p
Sex (Males)	2.3*	1.1–4.6	0.02
Blood alcoholic level	0.6*	0.4–0.9	0.02
Systolic arterial blood pressure min	1,0	0,9–1,0	0.3
Diastolic arterial blood pressure min	1,0	0,9–1,0	0.3
Cardiorespiratory arrest pre hospital	1,0	0,2–6,2	1
Hemoglobin	1,0	0,9–1,2	1
Catecholamine	1,1	0,4–3,2	0.8
Mechanical ventilation	0,9	0,4–3,4	0.8
PH>7,37	1,0	0,8–135	0.09
platelets	1,0	0,9–1,0	0.4
Fibrinogen >2 g/dL	1,4	1,0–2,1	0.09
Emergency procedure	0,9	0,2–3,8	0.9

Multivariate analysis with the different factors chosen in the analysis. *: independent association with normalization of lactate in the 24 first hours. OR: Odd Ratio. 95 CI: 95% confidence Interval