Intensive Care Medicine

, Volume 29, Issue 8, pp 1300–1305 | Cite as

Relationship between injury severity and lactate levels in severely injured patients

  • Ognjen CerovićEmail author
  • Vesna Golubović
  • Ana Špec-Marn
  • Boriana Kremžar
  • Gaj Vidmar



To determine the correlation of blood concentration of lactate and severity of injury and survival in severely injured patients.

Design and setting

A prospective study of severely injured patients admitted directly from an emergency surgical unit to a surgical intensive care unit with an Injury Severity Score (ISS) of 16 points or more. The study was conducted over 30 months.


98 severely injured subjects aged between 16 and 82 years with ISS range from 16 to 75 points, overall 25.5% mortality.


Blood lactate concentrations were measured once on admission, twice daily during the first 2 days and once daily during the next 3 days. ISS, Revised Trauma Score, Shock Index, and Trauma and Injury Severity Score were calculated for each subject.

Measurements and results

Of 98 severely injured patients 91 had elevated blood lactate concentration (over 2.0 mmol/l). Regression analyses demonstrated that injury severity, as measured by ISS, can be predicted from lactate concentration on admission, while survival, either actual or predicted by Trauma and Injury Severity Score higher than 0.5, can be predicted from lactate concentration after 12 h. We also found that patients with Shock Index higher than 0.9 had significantly higher lactate levels during the first 36 h than those with values less than 0.9.


This study confirmed the relationship between blood lactate levels and injury severity as well as the prognostic value of blood lactate level for survival of severely injured patients.


Lactate Injury Injury Severity Score (ISS) Shock index (SI) Trauma Intensive Care Unit 


  1. 1.
    Frutiger A, Ray C, Bilat C, Rosso R, Furrer R, Cantieni R, Rüedi T, Leutenegger A (1991) Five years' follow-up of severely injured ICU patients. J Trauma 31:1216–1226PubMedGoogle Scholar
  2. 2.
    Baker J (1999) Blood lactate levels. Curr Opin Crit Care 5:234–239CrossRefGoogle Scholar
  3. 3.
    Kruse JA, Carlson RW (1987) Lactate metabolism. Crit Care Clin 5:725–746Google Scholar
  4. 4.
    Regel G, Grotz M, Weltner T, Sturm JA, Tscherne H (1996) Pattern of organ failure following severe trauma. World J Surg 20:422–429Google Scholar
  5. 5.
    Moomey CB, Melton SM, Croce MA, Fabian TC, Proctor KG (1999) Prognostic value of blood lactate, base deficit, and oxygen-derived variables in an LD50 model of penetrating trauma. Crit Care Med 27:154–161PubMedGoogle Scholar
  6. 6.
    Vitek V, Cowley RA (1991) Blood lactate in the prognosis of various forms of shock. Ann Surg 173:308–313Google Scholar
  7. 7.
    Bakker J (1996) Monitoring of blood lactate levels. Int J Intensive Care 3:29–39Google Scholar
  8. 8.
    Milzman D, Boulanger B, Wiles C, Hinson D (1992) Admission lactate predicts injury severity and outcome in trauma patients (abstract). Crit Care Med 21:S94Google Scholar
  9. 9.
    Sauaia A, Moore FA, Moore EE, Haenel JB, Read RA, Lezotte DC (1994) Early predictors of post injury multiple organ failure. Arch Surg 129:39–45PubMedGoogle Scholar
  10. 10.
    Association for the Advancement of Automotive Medicine (1990) The Abbreviated Injury Scale. USAGoogle Scholar
  11. 11.
    Baker SP, O'Neill B, Haddon W, Long WB (1974) The injury severity score: a method for describing patients with multiple injuries and evaluating emergency care. J Trauma 14:187–196PubMedGoogle Scholar
  12. 12.
    Champion HR, Sacco WJ, Copes WS, Gan DS, Gennarelli TA, Flanagan ME (1989) A revision of the Trauma Score. J Trauma 29:623–629PubMedGoogle Scholar
  13. 13.
    Boyd CR, Tolson MA, Copes WS (1987) Evaluation trauma care: the TRISS method. J Trauma 27:370–378PubMedGoogle Scholar
  14. 14.
    Rady MY (1992) The role of central venous oximetry, lactic acid concentration and shock index in the evaluation of clinical shock: a review. Resuscitation 24:55–60PubMedGoogle Scholar
  15. 15.
    Rady MY, Smithline HA, Blake H, Nowak R, Rivers E (1994) A comparison of the shock index and conventional vital signs to identify acute, critical illness in the emergency department. Ann Emerg Med 24:685–690PubMedGoogle Scholar
  16. 16.
    Committee on Trauma (1993) Advanced trauma life support course for physicians. American College of Surgeons, Chicago, pp 75–94Google Scholar
  17. 17.
    Martin LC (1997) Primary Triage of the Trauma Patient. In: Kitby RR, Taylor RW, Civetta JM (ed) Handbook of critical care, 2nd edn. Lipincott-Raven, Philadelphia, pp 367–375Google Scholar
  18. 18.
    Vitros Test Methodologies (1996) Chapter: Lactate. Johnson & Johnson Clinical Diagnostics, RochesterGoogle Scholar
  19. 19.
    Abramson D, Scales T, Hitchcock R, Trooskin SZ, Henry SM, Greenspan J (1993) Lactate clearance and survival following injury. J Trauma 35:584–589PubMedGoogle Scholar
  20. 20.
    Roumen RMH, Redl H, Schlag G, Sandtner W, Koller W, Goris JA (1993) Scoring systems and blood lactate concentrations in relation to the development of adult respiratory distress syndrome and multiple organ failure in severely traumatized patients. J Trauma 35:349–355PubMedGoogle Scholar
  21. 21.
    Manikis P, Jankowski S, Zhang H, Kahn R, Vincent JL (1995) Correlation of serial blood lactate levels to organ failure and mortality after trauma. Am J Emerg Med 13:619–622PubMedGoogle Scholar
  22. 22.
    Kremžar B, Špec-Marn A, Kompan L, Cerovic O (1997) Normal values of SvO2 as therapeutic goal in patients with multiples injuries. Intensive Care Med 23:65–70CrossRefPubMedGoogle Scholar
  23. 23.
    Sluis CK van der, Klasen HJ, Eisma WH, ten Duis HJ (1996) Major trauma in young and old: What is the difference? J Trauma 40:78–82Google Scholar
  24. 24.
    Sacco WJ, Copes WS, Bain LW, MacKenzie EJ, Frey CF, Hoyt DB, Weigelt JA, Champion HR (1993) Effect of preinjury illness on trauma patient survival outcome. J Trauma 35:538–543PubMedGoogle Scholar
  25. 25.
    Peng R, Chang C, Gilmore D, Bongard F (1998) Epidemiology of immediate and early trauma death at an urban level I trauma center. Am Surg 64:950–954PubMedGoogle Scholar
  26. 26.
    Baker CC, Oppenheimer L, Stephens B, Lewis FR, Trunkey DD (1980) Epidemiology of trauma deaths. Am J Surg 140:144–150PubMedGoogle Scholar
  27. 27.
    Cummings P (1990) Cause of death in an emergency department. Am J Emerg Med 8:379–384PubMedGoogle Scholar
  28. 28.
    Gilpin DA, Nelson PG (1991) Revised trauma score: a triage tool in the accident and emergency department. Injury 22:35–37PubMedGoogle Scholar
  29. 29.
    Luft D, Deichsel G, Schmülling RM, Stein W, Eggstein M (1983) Definition of clinically relevant lactic acidosis in patients with internal diseases. Am J Clin Pathol 80:484–489PubMedGoogle Scholar
  30. 30.
    Broder G, Weil MH (1964) Excess lactate: an index of reversibility of shock in human patients. Science 143:1457–1459Google Scholar
  31. 31.
    Weil MH, Afifi AA (1970) Experimental and clinical studies on lactate and pyruvate as indicators of the severity of acute circulatory failure (shock). Circulation 41:989–1001PubMedGoogle Scholar
  32. 32.
    Oppenheim WL (1980) Early biochemical changes and severity of injury on man. J Trauma 20:135–140PubMedGoogle Scholar

Copyright information

© Springer-Verlag 2003

Authors and Affiliations

  • Ognjen Cerović
    • 1
    • 2
    Email author
  • Vesna Golubović
    • 3
  • Ana Špec-Marn
    • 2
  • Boriana Kremžar
    • 2
  • Gaj Vidmar
    • 4
  1. 1.LjubljanaSlovenia
  2. 2.Department of Surgical Intensive Care, Clinical Department of Anaesthesiology and Intensive TherapyUniversity Medical Center LjubljanaLjubljanaSlovenia
  3. 3.Clinical Hospital CenterRijekaCroatia
  4. 4.Institute of Biomedical Informatics, Faculty of MedicineUniversity of LjubljanaLjubljanaSlovenia

Personalised recommendations