The usefulness of lactate as an early predictor of the severity of emergency department patients with postpartum hemorrhage

ABSTRACT

OBJECTIVE: Only a few studies have examined the role of lactate reflecting on tissue hypoperfusion determining the severity of postpartum hemorrhage (PPH) patients in the emergency department (ED). This study evaluated the utility of the arterial lactate level as a prognostic marker of severity in PPH patients admitted to an ED. METHODS: This retrospective, observational cohort study was conducted on patients integrated prospectively in a critical pathway of SPEED (Severance Protocol to save postpartum bleeding through Expeditious care Delivery). Adult primary PPH patients admitted to the ED between July 1, 2010 and March 31, 2017 were analyzed. The outcomes were the development of severe PPH including death, hysterectomy, surgical treatment, and massive transfusion. RESULTS: A total of 112 patients were enrolled in this study. An increase in the arterial lactate value was a strong independent predictor of severe PPH. The increasing predictability of severe PPH was closely associated with an arterial lactate ≥3.15 mL/L at admission (odds ratio, 13.870; P < 0.001). CONCLUSION: Lactate is an independent predictor of severe PPH and is suitable for a rapid and simple estimation of the severity of PPH. Emergency physicians can use lactate to determine the initial treatment strategies more precisely.