Lactate clearance predicts outcome after major trauma

ABSTRACT

Introduction:To determine a correlation between lactate clearance within 48h and survival in trauma patients at a Level I trauma centre in a developing country and compare to previous international lactate clearance studies.Methods:We conducted a retrospective study of a prospectively collected database at a Level I trauma centre from March 2007 to November 2010. Patients of all ages were included. Metabolic parameters from initial arterial blood gas were measured in all patients; an abnormal lactate beindefined as 2.5mmol/L. A subgroup analysis of blunt versus penetrating injury was performed. Results:Of the 657 patients in the database; 493 had complete lactate data. The survival rate of patients with lactate values 2.5mmol/L was 88. Of the patients with high lactate levels that cleared within 24 and 48h the survival rates were 81 and 71; respectively. The survival rate amongst patients not achieving a normal lactate within 48h was 46 but was higher in those with penetrating as opposed to blunt injury (67 versus 38). The overall survival was 81.Conclusion:The present results confirm previous studies showing that prolonged lactate clearance predicts increased mortality in severely injured trauma patients. Thus; the measurements of arterial serum lactate trends are simple and effective predictors of outcome: