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Lactate clearance metrics are not superior to initial lactate in predicting mortality in trauma

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European Journal of Trauma and Emergency Surgery Aims and scope Submit manuscript

Abstract

Purpose

Despite the availability of different lactate clearance (LC) metrics for clinical use, it remains unknown which metric is superior as a clinical predictor for outcome, particularly in trauma patients. This retrospective study compared four previously described metrics of LC and examined the association between LC and outcome in trauma patients.

Methods

Lactate values of trauma patients admitted to a level I trauma center between 2010 and 2013 were retrieved from patient records. LC was calculated according to Huckabee, Regnier et al., Billeter et al. and Zhang et al. Patients were categorized as isolated traumatic brain injury (TBI), trauma with TBI, and trauma without TBI. The primary study outcome was in-hospital mortality.

Results

367 trauma patients were eligible for LC calculation. Only LC by Zhang et al. [area under the curve (AUC) > 0.622, p < 0.01], and Billeter et al. (AUC > 0.616, p < 0.05) were predictive for mortality in trauma patients with and without TBI. However, both were equally prognostic as the initial lactate value for in-hospital mortality. The prognostic value of initial lactate and lactate clearance for in-hospital mortality were not found to differ between isolated TBI, polytrauma with TBI, and trauma without TBI.

Conclusions

LC metrics based on the methods of Zhang et al. and Billeter et al. predicted mortality in trauma patients, and their prognostic value did not differ between patients with and without TBI. However, initial lactate value was equally prognostic as these LC metrics. Our findings suggest that a single initial lactate measurement may be a more clinically useful tool to predict mortality than the calculation of lactate clearance.

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Acknowledgments

We would like to thank the Royal Netherlands Academy of Arts and Sciences (Koninklijke Nederlandse Akademie van Wetenschappen [KNAW]) for providing S.E.D. with generous travel support to present this work at the 11th Annual Academic Surgical Congress, Jacksonville, Florida, USA.

Authors’ contributions

SE.D., HM.d.V., W.D.L. and C.B. contributed to conception and design; S.E.D., HM.d.V. and P.v.d.V. analyzed and interpreted the data; S.E.D., HM.d.V., W.D.L., A.T., F.W.B., L.M.G.G.Jr., P.S., and C.B collected data; S.E.D., drafted the article; HM.d.V., W.D.L., P.v.d.V., A.T., F.W.B., L.M.G.G., P.S., and C.B. critically revised the article for important intellectual content.

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Authors and Affiliations

  1. Department of Anesthesiology, Institute for Cardiovascular Research, VU University Medical Center, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands

    S. E. Dekker, H.-M. de Vries, W. D. Lubbers, P. Schober & C. Boer

  2. Department of Epidemiology and Biostatistics, VU University Medical Center, Amsterdam, The Netherlands

    P. M. van de Ven

  3. Center For Acute Care, VU Medical Center Region, Amsterdam, The Netherlands

    E. J. Toor

  4. Department of Trauma Surgery, VU University Medical Center, Amsterdam, The Netherlands

    F. W. Bloemers & L. M. G. Geeraedts Jr.

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  1. S. E. Dekker
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  8. P. Schober
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  9. C. Boer
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Corresponding author

Correspondence to S. E. Dekker.

Ethics declarations

Simone E. Dekker, Hielke-Martijn de Vries, Wouter D. Lubbers, Peter M. van de Ven, Annelies Toor, Frank W. Bloemers, Leo M.G. Geeraedts Jr., Patrick Schober, and Christa Boer have no disclosures related to the study. This was a retrospective study and did not require informed consent. Therefore, the Local Human Subject Committee of the VU University Medical Center (Amsterdam, the Netherlands) approved the study and waived informed consent.

Conflict of interest

Simone E. Dekker, Hielke-Martijn de Vries, Wouter D. Lubbers, Peter M. van de Ven, Annelies Toor, Frank W. Bloemers, Leo M.G. Geeraedts Jr., Patrick Schober, and Christa Boer have no conflicts of interest to declare.

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Dekker, S.E., de Vries, HM., Lubbers, W.D. et al. Lactate clearance metrics are not superior to initial lactate in predicting mortality in trauma. Eur J Trauma Emerg Surg 43, 841–851 (2017). https://doi.org/10.1007/s00068-016-0733-y

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  • DOI: https://doi.org/10.1007/s00068-016-0733-y

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