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Early lactate clearance for predicting active bleeding in critically ill patients with acute upper gastrointestinal bleeding: a retrospective study

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Abstract

Not all patients with upper gastrointestinal bleeding (UGIB) require emergency endoscopy. Lactate clearance has been suggested as a parameter for predicting patient outcomes in various critical care settings. This study investigates whether lactate clearance can predict active bleeding in critically ill patients with UGIB. This single-center, retrospective, observational study included critically ill patients with UGIB who met all of the following criteria: admission to the emergency department (ED) from April 2011 to August 2014; had blood samples for lactate evaluation at least twice during the ED stay; and had emergency endoscopy within 6 h of ED presentation. The main outcome was active bleeding detected with emergency endoscopy. Classification and regression tree (CART) analyses were performed using variables associated with active bleeding to derive a prediction rule for active bleeding in critically ill UGIB patients. A total of 154 patients with UGIB were analyzed, and 31.2 % (48/154) had active bleeding. In the univariate analysis, lactate clearance was significantly lower in patients with active bleeding than in those without active bleeding (13 vs. 29 %, P < 0.001). Using the CART analysis, a prediction rule for active bleeding is derived, and includes three variables: lactate clearance; platelet count; and systolic blood pressure at ED presentation. The rule has 97.9 % (95 % CI 90.2–99.6 %) sensitivity with 32.1 % (28.6–32.9 %) specificity. Lactate clearance may be associated with active bleeding in critically ill patients with UGIB, and may be clinically useful as a component of a prediction rule for active bleeding.

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Acknowledgments

The authors wish to thank all the Emergency Department residents and attending staff at Center Hospital of the National Center for Global Health and Medicine for their kind help in this study. The authors acknowledge the contribution of the medical staff in the Department of Gastroenterology at Center Hospital of the National Center for Global Health and Medicine in the implementation of emergency endoscopy for each patient in the present study.

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Authors and Affiliations

  1. Department of Emergency and Critical Care Medicine, The University of Tokyo Hospital, 7-3-1 Hongo, Bunkyo-Ku, Tokyo, 113-8655, Japan

    Tomoki Wada & Naoki Yahagi

  2. Department of Emergency Medicine and Critical Care, Center Hospital of the National Center for Global Health and Medicine, 1-21-1 Toyama, Shinjuku-Ku, Tokyo, 162-8655, Japan

    Akiyoshi Hagiwara, Tatsuki Uemura & Akio Kimura

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  1. Tomoki Wada
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  2. Akiyoshi Hagiwara
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  3. Tatsuki Uemura
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  4. Naoki Yahagi
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  5. Akio Kimura
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Correspondence to Tomoki Wada.

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The authors have no conflicts of interest to declare.

Statement of human and animal rights

The present study was conducted in accordance with the amended Declaration of Helsinki. The Ethics Committee of Center Hospital of the National Center for Global Health and Medicine approved this study.

Informed consent

The requirement for written informed consent from patients was waived because the study design formed part of the current standard of care in the ED, and patient data were anonymous.

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Wada, T., Hagiwara, A., Uemura, T. et al. Early lactate clearance for predicting active bleeding in critically ill patients with acute upper gastrointestinal bleeding: a retrospective study. Intern Emerg Med 11, 737–743 (2016). https://doi.org/10.1007/s11739-016-1392-z

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  • DOI: https://doi.org/10.1007/s11739-016-1392-z

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