The clinical significance of blood lactate monitoring at admission in the elderly with hip fractures / 中华老年医学杂志

ABSTRACT

Objective:To study the predictive value of high serum lactate for the risk of death after hip fractures.Methods:Data of hip fracture patients admitted to the authors' unit from January 2012 to December 2016 were analyzed retrospectively.A total of 1004 patients were included.According to the receiver operating characteristic(ROC), the predictive values of lactate for predicting the risk of death 30 days and 1 year after hip surgery were obtained.Results:The mortality rates of patients with serum hyperlactatemia were 10.8% and 23.3% for 30 days and 1 year after surgery, respectively.The 30-day and 1-year mortality rates for patients in the normal group were 1.3% and 11.8%, respectively.The differences between the two groups were statistically significant( χ2=47.764, 27.433, P=0.000 for both). The average survival time was(23.9±16.6)m for patients in the hyperlactatemia group and(28.8±16.5)m for subjects in the normal group, with a significant difference between the two groups( t=4.340, P=0.000). The incidences of complications were 28.6% for the serum hyperlactatemia group and 21.9% for the normal lactate group.There were significant differences between the two groups( χ2=5.249, P=0.022). The average length of stay was(13.6±8.7)d for the hyperlactatemia group and(12.5±7.8)d for the normal group, with the difference showing statistical significance( t=1.988, P=0.047). Lactate levels were able to predict the risk of death 30 days after hip fracture surgery.The predicted cutoff value was 2.35 mmol/L, the sensitivity and specificity were 0.744 and 0.834, respectively, and the area under the curve was 0.829. Conclusions:The incidence of hyperlactatemia after hip fractures is high.Compared with hip fracture patients with normal lactate levels, patients with hyperlactatemia show longer hospital stays, a higher incidence of complications, and higher mortality rates within 30 days and 1 year of surgery.Lactate levels(2.35 mmol/L)may be used to predict the risk of death within 30 days of hip fracture surgery.