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Admission serum lactate levels do not predict mortality in the acutely injured patient.
Pal, Jay D; Victorino, Gregory P; Twomey, Patrick; Liu, Terrence H; Bullard, M Kelley; Harken, Alden H.
Afiliación
  • Pal JD; Department of Surgery, University of California, San Francisco-East Bay, Oakland, California 94602, USA.
J Trauma ; 60(3): 583-7; discussion 587-9, 2006 Mar.
Article en En | MEDLINE | ID: mdl-16531858
INTRODUCTION: The conventional view that admission lactate levels predict outcome in trauma patients stems from simple comparisons of mean blood levels between groups and small sample sizes. To better address this question, we performed more rigorous statistical analyses of lactate in a larger patient sample. METHODS: We prospectively collected data on admission lactate and outcomes in 5,995 patients admitted to an urban, university-based trauma center. The ability of admission lactate to predict mortality was assessed by logistic regression, calculation of positive predictive values (PPV), and measurement of areas under receiver operating characteristic (ROC) curves. RESULTS: Differences between survivors and nonsurvivors in means of most proposed prognosticators was again demonstrated. However, the large overlap in these variables between survivors and nonsurvivors prevented clinically useful predictions. The overall PPV of elevated lactate was only 5.4%. Even in severely injured patients (Injury Severity Score >20; mortality 23%), elevated admission lactate level was a poor predictor of outcome. ROC analyses found no useful sensitivity threshold overall or after stratification by age, sex, Glasgow Coma Scale score, revised trauma score, or mechanism of injury. CONCLUSIONS: This large retrospective examination of admission lactate levels failed to show useful predictive accuracy for hospital death. Serum lactate levels need not be obtained routinely but can be reserved for patients who will be admitted to the intensive care unit and/or require an emergency operation.
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Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Admisión del Paciente / Heridas y Lesiones / Ácido Láctico Tipo de estudio: Diagnostic_studies / Observational_studies / Prognostic_studies / Risk_factors_studies Límite: Adult / Female / Humans / Male País/Región como asunto: America do norte Idioma: En Revista: J Trauma Año: 2006 Tipo del documento: Article País de afiliación: Estados Unidos Pais de publicación: Estados Unidos
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Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Admisión del Paciente / Heridas y Lesiones / Ácido Láctico Tipo de estudio: Diagnostic_studies / Observational_studies / Prognostic_studies / Risk_factors_studies Límite: Adult / Female / Humans / Male País/Región como asunto: America do norte Idioma: En Revista: J Trauma Año: 2006 Tipo del documento: Article País de afiliación: Estados Unidos Pais de publicación: Estados Unidos