Correlation of serial blood lactate levels to organ failure and mortality after trauma

• Published in: The American journal of emergency medicine Vol. 13; no. 6; pp. 619 - 622
• Main Authors: Manikis, Panagiotis, Jankowski, Stanislaw, Zhang, Haibo, Kahn, Robert J, Vincent, Jean-Louis
• Format: Journal Article
• Language: English
• Published: Philadelphia, PA Elsevier Inc 01-11-1995; Elsevier
• Subjects: Acute Kidney Injury - blood; Adolescent; Adult; Aged; Aged, 80 and over; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Biological and medical sciences; Blood Coagulation Disorders - blood; Emergency and intensive care: injuries, diseases due to physical agents. Diving. Drowning. Disaster medicine; Glasgow Coma Scale; Humans; Injury Severity Score; Intensive care medicine; Lactate; Lactates - blood; Liver Failure - blood; Medical sciences; Middle Aged; Multiple Organ Failure - blood; Multiple Organ Failure - physiopathology; organ failure; outcome; polytrauma; Respiratory Insufficiency - blood; Trauma Severity Indices; Wounds and Injuries - blood; Wounds and Injuries - mortality; Wounds and Injuries - physiopathology; Lactate; outcome; polytrauma; organ failure; Assay; Human; Lactates; Intensive care; Correlation; Mortality; Multiple organ failure; Biological indicator; Severity score; Trauma; Morbidity; Blood plasma
• ISSN: 0735-6757; 1532-8171
• DOI: 10.1016/0735-6757(95)90043-8

To define the value of serial measurements of blood lactate levels after trauma, the present study investigated the correlation between blood lactate, mortality, and organ failure in 129 trauma patients, including 100 intensive care unit (ICU) survivors and 29 ICU fatalities. On admission, injury severity score (ISS) was higher and Glasgow coma score (GCS), revised trauma score (RTS), and trauma revised ISS (TRISS) were lower in the nonsurvivors than in the survivors. Serial arterial blood lactate levels were measured on admission and at least three times a day until normalization. Both initial lactate and highest lactate levels were higher in the nonsurvivors than in the survivors. Organ failure developed in 84 (65%) of the 129 patients. Patients with organ failure had significantly lower RTS and TRISS. Initial lactate and highest lactate levels were significantly higher in patients with organ failure than without organ failure (3.4 [0.7 to 12.7] versus 2.4 [0.4 to 7.6] mEq/L and 4.1 [0.7 to 12.7] versus 2.8 [0.4 to 8.9] mEq/L, respectively, both
P < .01). The duration of hyperlactatemia averaged 2.2 days in the former but 1.0 day in the latter patients (
P < .01). The data therefore indicate that not only the initial or the highest lactate value but also the duration of hyperlactatemia can be correlated with the development of organ failure. These observations stress the importance of the initial resuscitation in the prevention of organ failure. Serial blood lactate measurements are reliable indicators of morbidity and mortality after trauma.