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Abel B, Gerling KA, Mares JA, Hutzler J, Pierskalla I, Hays J, Propper B, White JM, Burmeister DM. Real-Time Measurements of Oral Mucosal Carbon Dioxide (POMCO2) Reveals an Inverse Correlation With Blood Pressure in a Porcine Model of Coagulopathic Junctional Hemorrhage. Mil Med 2024; 189:e612-e619. [PMID: 37632757 DOI: 10.1093/milmed/usad336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Revised: 06/28/2023] [Accepted: 08/11/2023] [Indexed: 08/28/2023] Open
Abstract
INTRODUCTION Shock states that occur during, for example, profound hemorrhage can cause global tissue hypoperfusion leading to organ failure. There is an unmet need for a reliable marker of tissue perfusion during hemorrhage that can be followed longitudinally. Herein, we investigated whether longitudinal POMCO2 tracks changes in hemodynamics in a swine model of coagulopathic uncontrolled junctional hemorrhage. MATERIALS AND METHODS Female Yorkshire-crossbreed swine (n = 7, 68.1 ± 0.7 kg) were anesthetized and instrumented for continuous measurement of mean arterial pressure (MAP). Coagulopathy was induced by the exchange of 50 to 60% of blood volume with 6% Hetastarch over 30 minutes to target a hematocrit of <15%. A 4.5-mm arteriotomy was made in the right common femoral artery with 30 seconds of free bleeding. POMCO2 was continuously measured from baseline through hemodilution, hemorrhage, and a subsequent 3-h intensive care unit period. Rotational thromboelastometry and blood gases were measured. RESULTS POMCO2 and MAP showed no significant changes during the hemodilution phase of the experiment, which produced coagulopathy evidenced by prolonged clot formation times. However, POMCO2 increased because of the uncontrolled hemorrhage by 11.3 ± 3.1 mmHg and was inversely correlated with the drop (17.9 ± 5.9 mmHg) in MAP (Y = -0.4122*X + 2.649, P = .02, r2 = 0.686). In contrast, lactate did not significantly correlate with the changes in MAP (P = .35) or POMCO2 (P = .37). CONCLUSIONS Despite the logical appeal of measuring noninvasive tissue CO2 measurement as a surrogate for gastrointestinal perfusion, prior studies have only reported snapshots of this readout. The present investigation shows real-time longitudinal measurement of POMCO2 to confirm that MAP inversely correlates to POMCO2 in the face of coagulopathy. The simplicity of measuring POMCO2 in real time can provide an additional practical option for military or civilian medics to monitor trends in hypoperfusion during hemorrhagic shock.
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Affiliation(s)
- Biebele Abel
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, MD 20817, USA
- Department of Surgery, Uniformed Services University of the Health Science, Bethesda, MD 20814, USA
| | | | - John A Mares
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, MD 20817, USA
- Department of Surgery, Uniformed Services University of the Health Science, Bethesda, MD 20814, USA
| | - Justin Hutzler
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, MD 20817, USA
- Department of Surgery, Uniformed Services University of the Health Science, Bethesda, MD 20814, USA
| | | | - Jim Hays
- ExoStat Medical, Inc., Prior Lake, MN 55372, USA
| | - Brandon Propper
- Department of Surgery, Uniformed Services University of the Health Science, Bethesda, MD 20814, USA
- Walter Reed National Military Medical Center, Bethesda, MD 20814, USA
| | - Joseph M White
- Division of Vascular Surgery and Endovascular Therapy, Johns Hopkins School of Medicine, Baltimore, MD 21287, USA
| | - David M Burmeister
- Department of Surgery, Uniformed Services University of the Health Science, Bethesda, MD 20814, USA
- Department of Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA
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Agrawal S, Smith M, Berg R, Hoskins IA. Serum Lactate Level as a Predictor for Blood Transfusion in Postpartum Hemorrhage. Am J Perinatol 2023; 40:1798-1802. [PMID: 34808683 DOI: 10.1055/s-0041-1740009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVE Postpartum hemorrhage (PPH) is the leading cause of maternal morbidity and mortality. At present, there are no reliable clinical or laboratory indicators to identify which patients might require blood transfusions during a PPH. Serum lactate has long been used as an early biomarker of tissue hypoperfusion in trauma settings. The aim of this study is to understand serum lactate's role in the management of obstetric hemorrhage. STUDY DESIGN A retrospective chart review was performed of women who delivered between 2016 and 2019 at our institution and experienced a PPH. The patients were divided into two groups: those with a normal serum lactate level, defined as ≤2 mmol/L, and those with an abnormal serum lactate level, defined as >2 mmol/L. Need for packed red blood cell transfusion, as part of the resuscitation, was assessed for both groups. RESULTS During the study period, 938 women experienced PPH. Of these, 108 (11.5%) had a normal serum lactate, ≤2 mmol/L, and 830 (88.5%) had an abnormal lactate, >2 mmol/L. Women with elevated lactate levels were more likely to receive a blood transfusion versus those with a normal lactate level (57.0 vs. 46.3%, p = 0.035, respectively). Additionally, the average number of blood transfusions administered was significantly higher in the abnormal lactate group versus in the normal lactate group (1.34 vs. 0.97, respectively, p = 0.004). In a multivariable linear regression model, increasing serum lactate levels were found to be predictive of requiring more than 1 unit of blood (p < 0.001). CONCLUSION Women with elevated serum lactate levels were more likely to require blood transfusions during a PPH versus those with a normal serum lactate level. Thus, serum lactate levels are useful as an early indicator of requirement for blood transfusion in the management of obstetric hemorrhage. KEY POINTS · Lactate is a biomarker for blood transfusion in trauma.. · Lactate's role in PPH is unknown.. · Elevated lactate predicts receiving more blood transfusions..
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Affiliation(s)
- Surbhi Agrawal
- Department of Obstetrics and Gynecology, New York University Langone Medical Center, New York, New York
| | - Maria Smith
- Department of Obstetrics and Gynecology, New York University Langone Medical Center, New York, New York
| | - Robert Berg
- Department of Obstetrics and Gynecology, New York University Langone Medical Center, New York, New York
| | - Iffath A Hoskins
- Department of Obstetrics and Gynecology, New York University Langone Medical Center, New York, New York
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Acute Kidney Injury: Iterative Development of an Audit Tool for Trauma Patients. J Trauma Nurs 2023; 30:108-114. [PMID: 36881703 DOI: 10.1097/jtn.0000000000000710] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/09/2023]
Abstract
BACKGROUND Acute kidney injury is a low-volume, high-risk complication in trauma patients and is associated with prolonged hospital length of stay and increased mortality. Yet, no audit tools exist to evaluate acute kidney injury in trauma patients. OBJECTIVE This study aimed to describe the iterative development of an audit tool to evaluate acute kidney injury following trauma. METHODS Our performance improvement nurses developed an audit tool to evaluate acute kidney injury in trauma patients using an iterative, multiphase process conducted from 2017 to 2021, which included a review of our Trauma Quality Improvement Program data, trauma registry data, literature review, multidisciplinary consensus approach, retrospective and concurrent review, and continuous audit and feedback for piloted and finalized versions of the tool. RESULTS The final acute kidney injury audit tool can be completed within 30 min using data obtained from the electronic medical record and consists of six sections, including identification criteria, source potential causes, source treatment, acute kidney injury treatment, dialysis indications, and outcome status. CONCLUSION The iterative development and testing of an acute kidney injury audit tool improved the uniform data collection, documentation, audit, and feedback of best practices to positively impact patient outcomes.
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Chung JS, Jang SW, Jung PY, Kim MJ, Choi YU, Bae KS, Kim S. Indicative factors for surgical or angiographic intervention in hemodynamically stable patients with blunt abdominal trauma: A retrospective cohort study. J Visc Surg 2023; 160:12-18. [PMID: 35459632 DOI: 10.1016/j.jviscsurg.2022.01.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
INTRODUCTION The standard of care for intraperitoneal injury in hemodynamically stable patients after blunt abdominal trauma has been replaced by non-operative management (NOM). However, selective NOM, depending on the situation, seems necessary in determining the treatment plan. In this study, we attempted to identify risk factors for surgical or angiographic intervention (SAI) in hemodynamically stable blunt abdominal trauma patients. METHODS This retrospective study which included adult patients who were brought to a regional trauma center was conducted from March 2015 to October 2019. We evaluated the characteristics of blunt abdominal trauma patients and analyzed factors that were related to the requirement of SAI in these patients. Patients were divided into SAI and conservative management (CM) groups. RESULTS We reviewed 1,176 patients, and after exclusions, of whom 248 blunt abdominal trauma and free fluid observed on CT were identified. The mean pulse rate was higher in the SAI than in the CM (P=0.025). Laboratory findings showed that lactate and delta neutrophil index (DNI) levels were higher in the SAI than in the CM (P=0.002 and 0.026 respectively). Additionally, the mean free fluid size in the SAI (85.69mm) was significantly larger than that in the CM (68.12mm; P=0.001), and blush was more frequently observed in the SAI (P<0.001). In multivariate analysis, only blush was an independent prognostic factor for SAI (OR 11.7, 95% CI, 5.1-30.8, P<0.001). CONCLUSION In hemodynamically stable patients with blunt abdominal trauma, blush but also high lactate and DNI are associated with the requirement of interventional radiology and/or surgery.
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Affiliation(s)
- J S Chung
- Department of Surgery, Trauma Center, Yonsei University Wonju College of Medicine, Wonju, Republic of Korea.
| | - S W Jang
- Department of Surgery, Trauma Center, Yonsei University Wonju College of Medicine, Wonju, Republic of Korea.
| | - P Y Jung
- Department of Surgery, Trauma Center, Yonsei University Wonju College of Medicine, Wonju, Republic of Korea.
| | - M J Kim
- Department of Surgery, Trauma Center, Yonsei University Wonju College of Medicine, Wonju, Republic of Korea.
| | - Y U Choi
- Department of Surgery, Trauma Center, Yonsei University Wonju College of Medicine, Wonju, Republic of Korea.
| | - K S Bae
- Department of Surgery, Trauma Center, Yonsei University Wonju College of Medicine, Wonju, Republic of Korea.
| | - S Kim
- Department of Surgery, Trauma Center, Yonsei University Wonju College of Medicine, Wonju, Republic of Korea.
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Chen S, Liu M, Feng D, Lv X, Wei J. A Novel Strategy for Predicting 72-h Mortality After Admission in Patients With Polytrauma: A Study on the Development and Validation of a Web-Based Calculator. Front Med (Lausanne) 2022; 9:799811. [PMID: 35492331 PMCID: PMC9046941 DOI: 10.3389/fmed.2022.799811] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Accepted: 03/15/2022] [Indexed: 11/13/2022] Open
Abstract
Background Early and accessible screening of patients with polytrauma at a high risk of hospital death is essential. The purpose of this research was to seek an accurate and convenient solution to predict deaths occurring within 72 h after admission of these patients. Methods A secondary analysis was conducted on 3,075 patients with polytrauma from the Dryad database. We imputed missing values in eligible individuals with the k-nearest neighbor algorithm and then randomly stratified them into the training group (n = 2,461) and the validation group (n = 614) based on a proportion of 8:2. The restricted cubic spline, univariate, backward stepwise, and multivariate logistic regression methods were employed to determine the suitable predictors. Calibration and receiver operating characteristic (ROC) curves were applied to assess the calibration and discrimination of the obtained model. The decision curve analysis was then chosen as the measure to examine the clinical usage. Results Age, the Glasgow Coma Scale score, the Injury Severity Score, base excess, and the initial lactate level were inferred as independent prognostic factors related to mortality. These factors were then integrated and applied to construct a model. The performance of calibration plots, ROC curves, and decision curve analysis indicated that the model had satisfactory predictive power for 72-h mortality after admission of patients with polytrauma. Moreover, we developed a nomogram for visualization and a web-based calculator for convenient application (https://songandwen.shinyapps.io/DynNomapp/). Conclusions A convenient web-based calculator was constructed to robustly estimate the risk of death in patients with polytrauma within 72 h after admission, which may aid in further rationalization of clinical decision-making and accurate individual treatment.
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Affiliation(s)
- Song Chen
- Department of Orthopaedic Trauma, East Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Meiyun Liu
- Department of Anesthesiology, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Di Feng
- Department of Anesthesiology, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Xin Lv
- Department of Anesthesiology, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Shanghai, China
- Xin Lv
| | - Juan Wei
- Department of Anesthesiology, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Shanghai, China
- *Correspondence: Juan Wei
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Wang R, Wang S, Zhang J, He M, Xu J. Serum Lactate Level in Early Stage Is Associated With Acute Kidney Injury in Traumatic Brain Injury Patients. Front Surg 2022; 8:761166. [PMID: 35174203 PMCID: PMC8841417 DOI: 10.3389/fsurg.2021.761166] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Accepted: 12/24/2021] [Indexed: 01/27/2023] Open
Abstract
Background Acute kidney injury (AKI) is a common complication in the clinical practice of managing patients with traumatic brain injury (TBI). Avoiding the development of AKI is beneficial for the prognosis of patients with TBI. We designed this study to testify whether serum lactate could be used as a predictive marker of AKI in patients with TBI. Materials and Methods In total, 243 patients with TBI admitted to our hospital were included in this study. Univariate and multivariate logistic regression analyses were utilized to analyze the association between lactate and AKI. The receiver operating characteristic (ROC) curves were drawn to verify the predictive value of lactate and the logistic model. Results Acute kidney injury group had higher age (p = 0.016), serum creatinine (p < 0.001), lactate (p < 0.001), and lower Glasgow Coma Scale (GCS; p = 0.021) than non-AKI group. Multivariate logistic regression showed that age [odds ratio (OR) = 1.026, p = 0.022], serum creatinine (OR = 1.020, p = 0.010), lactate (OR = 1.227, p = 0.031), fresh frozen plasma (FFP) transfusion (OR = 2.421, p = 0.045), and platelet transfusion (OR = 5.502, p = 0.044) were risk factors of AKI in patients with TBI. The area under the ROC curve (AUC) values of single lactate and predictive model were 0.740 and 0.807, respectively. Conclusion Serum lactate level in the early phase is associated with AKI in patients with TBI. Lactate is valuable for clinicians to evaluate the probability of AKI in patients with TBI.
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Affiliation(s)
- Ruoran Wang
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, China
| | - Shaobo Wang
- Department of Infectious Diseases, Xi'an Hospital of Traditional Chinese Medicine, Xi'an, China
| | - Jing Zhang
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, China
| | - Min He
- Department of Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, China
- *Correspondence: Min He
| | - Jianguo Xu
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, China
- Jianguo Xu
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7
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Endo Y, Hirokawa T, Miyasho T, Takegawa R, Shinozaki K, Rolston DM, Becker LB, Hayashida K. Monitoring the tissue perfusion during hemorrhagic shock and resuscitation: tissue-to-arterial carbon dioxide partial pressure gradient in a pig model. J Transl Med 2021; 19:390. [PMID: 34774068 PMCID: PMC8590759 DOI: 10.1186/s12967-021-03060-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2021] [Accepted: 08/27/2021] [Indexed: 11/20/2022] Open
Abstract
Background Despite much evidence supporting the monitoring of the divergence of transcutaneous partial pressure of carbon dioxide (tcPCO2) from arterial partial pressure carbon dioxide (artPCO2) as an indicator of the shock status, data are limited on the relationships of the gradient between tcPCO2 and artPCO2 (tc-artPCO2) with the systemic oxygen metabolism and hemodynamic parameters. Our study aimed to test the hypothesis that tc-artPCO2 can detect inadequate tissue perfusion during hemorrhagic shock and resuscitation. Methods This prospective animal study was performed using female pigs at a university-based experimental laboratory. Progressive massive hemorrhagic shock was induced in mechanically ventilated pigs by stepwise blood withdrawal. All animals were then resuscitated by transfusing the stored blood in stages. A transcutaneous monitor was attached to their ears to measure tcPCO2. A pulmonary artery catheter (PAC) and pulse index continuous cardiac output (PiCCO) were used to monitor cardiac output (CO) and several hemodynamic parameters. The relationships of tc-artPCO2 with the study parameters and systemic oxygen delivery (DO2) were analyzed. Results Hemorrhage and blood transfusion precisely impacted hemodynamic and laboratory data as expected. The tc-artPCO2 level markedly increased as CO decreased. There were significant correlations of tc-artPCO2 with DO2 and COs (DO2: r = − 0.83, CO by PAC: r = − 0.79; CO by PiCCO: r = − 0.74; all P < 0.0001). The critical level of oxygen delivery (DO2crit) was 11.72 mL/kg/min according to transcutaneous partial pressure of oxygen (threshold of 30 mmHg). Receiver operating characteristic curve analyses revealed that the value of tc-artPCO2 for discrimination of DO2crit was highest with an area under the curve (AUC) of 0.94, followed by shock index (AUC = 0.78; P < 0.04 vs tc-artPCO2), and lactate (AUC = 0.65; P < 0.001 vs tc-artPCO2). Conclusions Our observations suggest the less-invasive tc-artPCO2 monitoring can sensitively detect inadequate systemic oxygen supply during hemorrhagic shock. Further evaluations are required in different forms of shock in other large animal models and in humans to assess its usefulness, safety, and ability to predict outcomes in critical illnesses.
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Affiliation(s)
- Yusuke Endo
- The Feinstein Institutes for Medical Research, Northwell Health System, 350 Community Drive, Manhasset, NY, 11030, USA.,School of Veterinary Medicine, Rakuno Gakuen University, Hokkaido, Japan.,Department of Emergency Medicine, North Shore University Hospital, Northwell Health, Manhasset, NY, USA
| | - Taku Hirokawa
- School of Veterinary Medicine, Rakuno Gakuen University, Hokkaido, Japan
| | - Taku Miyasho
- School of Veterinary Medicine, Rakuno Gakuen University, Hokkaido, Japan
| | - Ryosuke Takegawa
- The Feinstein Institutes for Medical Research, Northwell Health System, 350 Community Drive, Manhasset, NY, 11030, USA.,Department of Emergency Medicine, North Shore University Hospital, Northwell Health, Manhasset, NY, USA
| | - Koichiro Shinozaki
- The Feinstein Institutes for Medical Research, Northwell Health System, 350 Community Drive, Manhasset, NY, 11030, USA.,Department of Emergency Medicine, North Shore University Hospital, Northwell Health, Manhasset, NY, USA.,Zucker School of Medicine at Hofstra/Northwell, New York, NY, USA
| | - Daniel M Rolston
- Department of Emergency Medicine, North Shore University Hospital, Northwell Health, Manhasset, NY, USA.,Zucker School of Medicine at Hofstra/Northwell, New York, NY, USA
| | - Lance B Becker
- The Feinstein Institutes for Medical Research, Northwell Health System, 350 Community Drive, Manhasset, NY, 11030, USA.,Department of Emergency Medicine, North Shore University Hospital, Northwell Health, Manhasset, NY, USA.,Zucker School of Medicine at Hofstra/Northwell, New York, NY, USA
| | - Kei Hayashida
- The Feinstein Institutes for Medical Research, Northwell Health System, 350 Community Drive, Manhasset, NY, 11030, USA. .,Department of Emergency Medicine, North Shore University Hospital, Northwell Health, Manhasset, NY, USA.
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Pattharanitima P, Thongprayoon C, Petnak T, Srivali N, Gembillo G, Kaewput W, Chesdachai S, Vallabhajosyula S, O’Corragain OA, Mao MA, Garovic VD, Qureshi F, Dillon JJ, Cheungpasitporn W. Machine Learning Consensus Clustering Approach for Patients with Lactic Acidosis in Intensive Care Units. J Pers Med 2021; 11:jpm11111132. [PMID: 34834484 PMCID: PMC8623582 DOI: 10.3390/jpm11111132] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Revised: 10/28/2021] [Accepted: 10/30/2021] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Lactic acidosis is a heterogeneous condition with multiple underlying causes and associated outcomes. The use of multi-dimensional patient data to subtype lactic acidosis can personalize patient care. Machine learning consensus clustering may identify lactic acidosis subgroups with unique clinical profiles and outcomes. METHODS We used the Medical Information Mart for Intensive Care III database to abstract electronic medical record data from patients admitted to intensive care units (ICU) in a tertiary care hospital in the United States. We included patients who developed lactic acidosis (defined as serum lactate ≥ 4 mmol/L) within 48 h of ICU admission. We performed consensus clustering analysis based on patient characteristics, comorbidities, vital signs, organ supports, and laboratory data to identify clinically distinct lactic acidosis subgroups. We calculated standardized mean differences to show key subgroup features. We compared outcomes among subgroups. RESULTS We identified 1919 patients with lactic acidosis. The algorithm revealed three best unique lactic acidosis subgroups based on patient variables. Cluster 1 (n = 554) was characterized by old age, elective admission to cardiac surgery ICU, vasopressor use, mechanical ventilation use, and higher pH and serum bicarbonate. Cluster 2 (n = 815) was characterized by young age, admission to trauma/surgical ICU with higher blood pressure, lower comorbidity burden, lower severity index, and less vasopressor use. Cluster 3 (n = 550) was characterized by admission to medical ICU, history of liver disease and coagulopathy, acute kidney injury, lower blood pressure, higher comorbidity burden, higher severity index, higher serum lactate, and lower pH and serum bicarbonate. Cluster 3 had the worst outcomes, while cluster 1 had the most favorable outcomes in terms of persistent lactic acidosis and mortality. CONCLUSIONS Consensus clustering analysis synthesized the pattern of clinical and laboratory data to reveal clinically distinct lactic acidosis subgroups with different outcomes.
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Affiliation(s)
- Pattharawin Pattharanitima
- Department of Internal Medicine, Faculty of Medicine, Thammasat University, Pathum Thani 12121, Thailand
- Correspondence: (P.P.); (C.T.); (W.C.)
| | - Charat Thongprayoon
- Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Rochester, MN 55905, USA; (V.D.G.); (F.Q.); (J.J.D.)
- Correspondence: (P.P.); (C.T.); (W.C.)
| | - Tananchai Petnak
- Division of Pulmonary and Pulmonary Critical Care Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok 10400, Thailand;
| | - Narat Srivali
- Division of Pulmonary Medicine, St. Agnes Hosipital, Baltimore, MD 21229, USA;
| | - Guido Gembillo
- Unit of Nephrology and Dialysis, Department of Clinical and Experimental Medicine, University of Messina, 98125 Messina, Italy;
| | - Wisit Kaewput
- Department of Military and Community Medicine, Phramongkutklao College of Medicine, Bangkok 10400, Thailand;
| | - Supavit Chesdachai
- Division of Infectious Disease, Department of Medicine, Mayo Clinic, Rochester, MN 55905, USA;
| | - Saraschandra Vallabhajosyula
- Section of Cardiovascular Medicine, Department of Medicine, Wake Forest University School of Medicine, Winston-Salem, NC 27101, USA;
| | - Oisin A. O’Corragain
- Department of Thoracic Medicine and Surgery, Temple University Hospital, Philadelphia, PA 19140, USA;
| | - Michael A. Mao
- Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Jacksonville, FL 32224, USA;
| | - Vesna D. Garovic
- Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Rochester, MN 55905, USA; (V.D.G.); (F.Q.); (J.J.D.)
| | - Fawad Qureshi
- Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Rochester, MN 55905, USA; (V.D.G.); (F.Q.); (J.J.D.)
| | - John J. Dillon
- Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Rochester, MN 55905, USA; (V.D.G.); (F.Q.); (J.J.D.)
| | - Wisit Cheungpasitporn
- Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Rochester, MN 55905, USA; (V.D.G.); (F.Q.); (J.J.D.)
- Correspondence: (P.P.); (C.T.); (W.C.)
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Machine Learning Prediction Models for Mortality in Intensive Care Unit Patients with Lactic Acidosis. J Clin Med 2021; 10:jcm10215021. [PMID: 34768540 PMCID: PMC8584535 DOI: 10.3390/jcm10215021] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2021] [Revised: 10/24/2021] [Accepted: 10/25/2021] [Indexed: 12/14/2022] Open
Abstract
Background: Lactic acidosis is the most common cause of anion gap metabolic acidosis in the intensive care unit (ICU), associated with poor outcomes including mortality. We sought to compare machine learning (ML) approaches versus logistic regression analysis for prediction of mortality in lactic acidosis patients admitted to the ICU. Methods: We used the Medical Information Mart for Intensive Care (MIMIC-III) database to identify ICU adult patients with lactic acidosis (serum lactate ≥4 mmol/L). The outcome of interest was hospital mortality. We developed prediction models using four ML approaches consisting of random forest (RF), decision tree (DT), extreme gradient boosting (XGBoost), artificial neural network (ANN), and statistical modeling with forward stepwise logistic regression using the testing dataset. We then assessed model performance using area under the receiver operating characteristic curve (AUROC), accuracy, precision, error rate, Matthews correlation coefficient (MCC), F1 score, and assessed model calibration using the Brier score, in the independent testing dataset. Results: Of 1919 lactic acidosis ICU patients, 1535 and 384 were included in the training and testing dataset, respectively. Hospital mortality was 30%. RF had the highest AUROC at 0.83, followed by logistic regression 0.81, XGBoost 0.81, ANN 0.79, and DT 0.71. In addition, RF also had the highest accuracy (0.79), MCC (0.45), F1 score (0.56), and lowest error rate (21.4%). The RF model was the most well-calibrated. The Brier score for RF, DT, XGBoost, ANN, and multivariable logistic regression was 0.15, 0.19, 0.18, 0.19, and 0.16, respectively. The RF model outperformed multivariable logistic regression model, SOFA score (AUROC 0.74), SAP II score (AUROC 0.77), and Charlson score (AUROC 0.69). Conclusion: The ML prediction model using RF algorithm provided the highest predictive performance for hospital mortality among ICU patient with lactic acidosis.
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Qi J, Bao L, Yang P, Chen D. Comparison of base excess, lactate and pH predicting 72-h mortality of multiple trauma. BMC Emerg Med 2021; 21:80. [PMID: 34233612 PMCID: PMC8262006 DOI: 10.1186/s12873-021-00465-9] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2021] [Accepted: 06/09/2021] [Indexed: 11/18/2022] Open
Abstract
Objective To compare the predictive values of base excess (BE), lactate and pH of admission arterial blood gas for 72-h mortality in patients with multiple trauma. Methods This was a secondary analysis based on a publicly shared trauma dataset from the Dryad database, which provided the clinical data of 3669 multiple trauma patients with ISS > = 16. The records of BE, lactate, pH and 72-h prognosis data without missing values were selected from this dataset and 2441 individuals were enrolled in the study. Logistic regression model was performed to calculate the odds ratios (ORs) of variables. Area under the curve (AUC) of receiver operating curve (ROC) was utilized to evaluate the predictive value of predictors for 72 h in-hospital mortality. Pairwise comparison of AUCs was performed using the Delong’s test. Results The statistically significant correlations were observed between BE and lactate (r = − 0.5861, p < 0.05), lactate and pH (r = − 0.5039, p < 0.05), and BE and pH (r = − 0.7433, p < 0.05). The adjusted ORs of BE, lactate and pH for 72-h mortality with the adjustment for factors including gender, age, ISS category were 0.872 (95%CI: 0.854–0.890), 1.353 (95%CI: 1.296–1.413) and 0.007 (95%CI: 0.003–0.016), respectively. The AUCs of BE, lactate and pH were 0.693 (95%CI: 0.675–0.712), 0.715 (95%CI: 0.697–0.733), 0.670 (95%CI: 0.651–0.689), respectively. Conclusions There are significant correlations between BE, lactate and pH of the admission blood gas, all of them are independent predictors of 72-h mortality for multiple trauma. Lactate may have the best predictive value, followed by BE, and finally pH.
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Affiliation(s)
- Junfang Qi
- Division of Emergency Medicine, the First Affiliated Hospital of Soochow University, Suzhou, China
| | - Long Bao
- Division of Emergency Medicine, the First Affiliated Hospital of Soochow University, Suzhou, China
| | - Peng Yang
- Division of Emergency Medicine, the First Affiliated Hospital of Soochow University, Suzhou, China
| | - Du Chen
- Division of Critical Care Medicine, the First Affiliated Hospital of Soochow University, Suzhou, China.
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Whitehead MC, Petritz OA, Doerr M, Stoskopf MK, Harrison TM. Biochemical Effects of Routine Gonadectomy on Blood of Domestic Ferrets ( Mustela putorius furo). JOURNAL OF THE AMERICAN ASSOCIATION FOR LABORATORY ANIMAL SCIENCE 2020; 59:567-574. [PMID: 32586412 DOI: 10.30802/aalas-jaalas-19-000173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
We studied domestic ferrets (Mustela putorius furo) to evaluate the physiologic effects of routine surgery. Standard plasma biochemistry panels and 1H-NMR spectroscopy of heparinized whole blood were performed on samples taken 24 h prior to and immediately after surgery from female and male ferrets undergoing routine gonadectomy. Increases in plasma glucose, phosphorus, potassium, and creatine kinase concentrations associated with the duration of surgery were identified on plasma biochemistry panels. Whole-blood NMR spectra allowed us to identify 42 metabolites and one drug residue. Variations between pre- and postoperative metabolite concentrations were most pronounced for female ferrets, which underwent more prolonged surgery than males. Affected metabolites included organic acids and osmolytes (betaine, methylmalonate, <small>D</small>-lactate), fatty acids and lipids (2-hydroxy-3-methylbutyric acid), and amino acid groups (acetylglycine, alloisoleucine, leucine, and isoleucine). These findings indicate that 1H-NMR spectroscopy of whole blood provides insight into metabolic perturbations in domestic ferrets undergoing surgery that are not detected in routine clinical chemistry panels.
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Affiliation(s)
- Michelle C Whitehead
- Department of Clinical Sciences, College of Veterinary Medicine, North Carolina State University, Raleigh, North Carolina; Environmental Medicine Consortium, North Carolina State University, Raleigh, North Carolina
| | - Olivia A Petritz
- Department of Clinical Sciences, College of Veterinary Medicine, North Carolina State University, Raleigh, North Carolina; Environmental Medicine Consortium, North Carolina State University, Raleigh, North Carolina;,
| | - Mary Doerr
- Department of Clinical Sciences, College of Veterinary Medicine, North Carolina State University, Raleigh, North Carolina; Environmental Medicine Consortium, North Carolina State University, Raleigh, North Carolina
| | - Michael K Stoskopf
- Department of Clinical Sciences, College of Veterinary Medicine, North Carolina State University, Raleigh, North Carolina; Environmental Medicine Consortium, North Carolina State University, Raleigh, North Carolina; Center for Marine Science and Technology, North Carolina State University, Morehead City, North Carolina
| | - Tara M Harrison
- Department of Clinical Sciences, College of Veterinary Medicine, North Carolina State University, Raleigh, North Carolina; Environmental Medicine Consortium, North Carolina State University, Raleigh, North Carolina
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Taniguchi H, Doi T, Abe T, Takeuchi I. Trauma severity associated with stress index in emergency settings: an observational prediction-and-validation study. Acute Med Surg 2020; 7:e493. [PMID: 33391764 PMCID: PMC7774291 DOI: 10.1002/ams2.493] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Revised: 01/23/2020] [Accepted: 02/05/2020] [Indexed: 11/23/2022] Open
Abstract
Aim Early judgments for treating severe trauma patients are essential for life‐saving. Stress index (SI), obtained from a division of blood glucose level by serum potassium at arrival, might be useful for early prediction. However, the efficacy of SI was unknown. The purpose of this study was to identify and validate prediction models of severe trauma (ST) and the need for damage control operation (DCOP) and massive transfusion (MT) by using SI among trauma patients. Methods This study was a retrospective and prospective observational study. The prediction models were created by 1‐year retrospective data of 167 trauma patients. The prediction models were validated by 6 months of prospective data of 87 trauma patients. Results The prediction model for ST contained respiratory rate and SI as significant factors. The prediction model for DCOP contained SI. The prediction model for MT contained systolic blood pressure and SI. The correlation of probability of MT, ST, and DCOP was r = 0.70 (P < 0.001), r = 0.46 (P < 0.001), and r = 0.15 (P = 0.196), respectively. The predicted probability of MT, ST, and DCOP showed 0.93 (95% confidence interval [CI], 0.88–0.90) and 0.80 (95% CI, 0.74–0.86), and 0.79 (95% CI, 0.70–0.88). Conclusion We identified and validated our prediction models for ST and the need for DCOP and MT among trauma patients using SI as a main predictor. Our models indicated that fewer variables in an early phase of the treatment process can inform clinicians regarding how severe a patient is and which intervention is needed.
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Affiliation(s)
- Hayato Taniguchi
- Department of Emergency and Critical Care Medicine Yokosuka Kyousai Hospital Yokosuka Japan.,Department of Emergency Medicine Yokohama City University Graduate School of Medicine Yokohama Japan
| | - Tomoki Doi
- Department of Emergency and Critical Care Medicine Yokosuka Kyousai Hospital Yokosuka Japan.,Department of Emergency Medicine Yokohama City University Graduate School of Medicine Yokohama Japan
| | - Takeru Abe
- Department of Emergency Medicine Yokohama City University Graduate School of Medicine Yokohama Japan
| | - Ichiro Takeuchi
- Department of Emergency Medicine Yokohama City University Graduate School of Medicine Yokohama Japan
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Yadollahi M, Kashkooe A, Rezaiee R, Jamali K, Niakan MH. A Comparative Study of Injury Severity Scales as Predictors of Mortality in Trauma Patients: Which Scale Is the Best? Bull Emerg Trauma 2020; 8:27-33. [PMID: 32201699 PMCID: PMC7071938 DOI: 10.29252/beat-080105] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Objective: To compare the injury severity scales as predictors of mortality in trauma patients to search for the best scale. Methods: In a prospective cohort study and systematical random sampling conducted from March to September 2017, trauma patients over the age of 13 years were enrolled. The investigated variables were age, gender, systolic blood pressure, heart rate, respiratory rate, injured body region, Glasgow Coma Scale (GCS), injury severity score (ISS), revised trauma score (RTS), trauma injury severity score (TRISS) and the outcome. Results: Totally, 1410 trauma patients were followed up, out of which 68.5% were male. The participants’ mean age was 43.5±20.88 years. After adjusting the confounding effects, age over 60 years (OR=7.38, CI [3.91-13.93]), GCS<8 (OR=6.5, CI [2.38-18.16]), RTS<7.6 (OR=6.04, CI [2-13.7]), and TRISS<0.9 (OR=3.09, CI [1.39-6.88]) were determined as the most significant predictor variables for in-hospital mortality. The results of Receiver Operating Characteristic (ROC) curve revealed that TRISS had the highest area under the curve in comparison to other tests that were evaluated. Furthermore, TRISS had the highest sensitivity and specificity for scores higher than 96.15. By contrast, the sensitivity and specificity of GCS decreased for scores higher than 5.5. Conclusion: Our results showed that TRISS, RTS, GCS, and ISS were all very effective approaches for evaluating prognosis, mortality and probable complications in trauma patients; thus, these systems of injury evaluation and scoring are recommended to facilitate treatment. TRISS, RTS, and ISS had almost the same sensitivity that was higher than GCS, but GCS had the most specificity. Finally, TRISS was selected as the most efficient scale for predicting mortality.
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Affiliation(s)
- Mahnaz Yadollahi
- Trauma Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Ali Kashkooe
- Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Reza Rezaiee
- Trauma Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Kazem Jamali
- Trauma Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
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Park HO, Choi JY, Jang IS, Kim JD, Choi JW, Lee CE. Assessment of the Initial Risk Factors for Mortality among Patients with Severe Trauma on Admission to the Emergency Department. THE KOREAN JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY 2019; 52:400-408. [PMID: 31832376 PMCID: PMC6901184 DOI: 10.5090/kjtcs.2019.52.6.400] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/10/2019] [Revised: 08/08/2019] [Accepted: 08/10/2019] [Indexed: 11/17/2022]
Abstract
Background For decades, trauma has been recognized globally as a major cause of death. Reducing the mortality of patients with trauma is an extremely pressing issue, particularly for those with severe trauma. An early and accurate assessment of the risk of mortality among patients with severe trauma is important for improving patient outcomes. Methods We performed a retrospective medical record review of 582 patients with severe trauma admitted to the emergency department between July 2011 and June 2016. We analyzed the associations of in-hospital mortality with the baseline characteristics and initial biochemical markers of patients with severe trauma on admission. Results The overall in-hospital mortality rate was 14.9%. Multivariate logistic regression analysis showed that the patient’s Rapid Emergency Medicine Score (REMS; odds ratio [OR], 1.186; 95% confidence interval [CI], 1.018–1.383; p=0.029), Emergency Trauma Score (EMTRAS; OR, 2.168; 95% CI, 1.570–2.994; p<0.001), serum lactate levels (SLL; OR, 1.298; 95% CI, 1.118–1.507; p<0.001), and Injury Severity Score (ISS; OR, 1.038; 95% CI, 1.010–1.130; p=0.021) were significantly associated with in-hospital mortality. Conclusion The REMS, EMTRAS, and SLL can easily and rapidly be used as alternatives to the injury severity score to predict in-hospital mortality for patients who present to the emergency department with severe trauma.
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Affiliation(s)
- Hyun Oh Park
- Department of Thoracic and Cardiovascular Surgery, Gyeongsang National University Hospital, Gyeongsang National University College of Medicine, Jinju, Korea
| | - Jun Young Choi
- Department of Thoracic and Cardiovascular Surgery, Gyeongsang National University Hospital, Gyeongsang National University College of Medicine, Jinju, Korea
| | - In Seok Jang
- Department of Thoracic and Cardiovascular Surgery, Gyeongsang National University Hospital, Gyeongsang National University College of Medicine, Jinju, Korea
| | - Jong Duk Kim
- Department of Thoracic and Cardiovascular Surgery, Gyeongsang National University Hospital, Gyeongsang National University College of Medicine, Jinju, Korea
| | - Jae Won Choi
- Department of Thoracic and Cardiovascular Surgery, Gyeongsang National University Hospital, Gyeongsang National University College of Medicine, Jinju, Korea
| | - Chung Eun Lee
- Department of Thoracic and Cardiovascular Surgery, Gyeongsang National University Hospital, Gyeongsang National University College of Medicine, Jinju, Korea
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The impact of admission serum lactate on children with moderate to severe traumatic brain injury. PLoS One 2019; 14:e0222591. [PMID: 31536567 PMCID: PMC6752785 DOI: 10.1371/journal.pone.0222591] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2019] [Accepted: 09/03/2019] [Indexed: 11/29/2022] Open
Abstract
Background Lactate is used to evaluate the prognosis of adult patients with trauma. However, the prognostic significance of admission serum lactate in the setting of pediatric traumatic brain injury (TBI) is still unclear. We aim to investigate the impact of admission lactate on the outcome in children with moderate to severe TBI. Methods This retrospective study was conducted in a tertiary pediatric hospital between May 2012 and Jun 2018 included children with an admission Glasgow Coma Scale (GCS) of ≤13. Two hundred and thirteen patients were included in the analysis and 45 patients died in hospital. Results Admission lactate and glucose were significantly higher in non-survivors than those in survivors (P < 0.05). Admission lactate was positively correlated with admission glucose and negatively correlated with GCS in all patients (n = 213), subgroup of isolated TBI (n = 112) and subgroup of GCS ≤ 8 (n = 133), respectively. AUCs of lactate could significantly predict the mortality and were higher than those of glucose in all patients, subgroup of isolated TBI and subgroup of GCS ≤ 8, respectively. Multivariate logistic regression showed that admission lactate (Adjusted OR = 1.189; 95% CI: 1.002–1.410; P = 0.047) was independently associated with mortality, while admission glucose (Adjusted OR = 1.077; 95% CI: 0.978–1.186; P = 0.133) wasn’t an independent risk factor of death. Elevated admission lactate (> 2 mmol/L) was associated with death, reduced 14-day ventilation-free days, 14-day ICU-free days and 28-day hospital-free days. Conclusions Admission serum lactate can effectively predict the mortality of children with moderate to severe TBI. Elevated admission lactate is associated with death, reduced ventilator-free, ICU-free, and hospital-free days. Admission serum lactate could be used as a prognostic biomarker of mortality in children with moderate to severe TBI.
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16
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Clinical Performance and Utility of Point-of-Care Lactate Technology in Patient Care Pathways. ACTA ACUST UNITED AC 2019. [DOI: 10.1097/poc.0000000000000185] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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17
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Jouffroy R, Saade A, Philippe P, Carli P, Vivien B. Prognostic Value of Blood Lactate and Lactate Clearance in Refractory Cardiac Arrest Treated by Extracorporeal Life Support. Turk J Anaesthesiol Reanim 2019; 47:48-54. [PMID: 31276111 PMCID: PMC6598657 DOI: 10.5152/tjar.2018.96992] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2018] [Accepted: 07/08/2018] [Indexed: 06/09/2023] Open
Abstract
OBJECTIVE During cardiac arrest (CA) resuscitation, an 'ischaemia-reperfusion' syndrome occurs leading to multiorgan failure reflected by an increase in blood lactate. Blood lactate is a diagnosis and prognosis biomarker in extracorporeal life support (ECLS), but its kinetic appears more informative to assess a patient's outcome. The aim of the present study was to describe the prognostic value of blood lactate and lactate clearance (LC) 3 (H3) and 6 h (H6) after the initiation of ECLS in the treatment of refractory CA. METHODS Patients admitted to the intensive care unit for refractory CA were included. Lactate measurements were performed at the initiation of ECLS (H0) and at H3 and H6 upon the initiation of ECLS. LC was measured from 0 to 3 h (LC03), 0 to 6 h (LC06) and 3 to 6 h (LC36). The primary endpoint was in-hospital mortality within 28 days. RESULTS Sixty-six patients were enrolled in the study. Lactate levels were higher in deceased patients. Increased mortality was observed with increasing levels of lactate at H3 and H6 and with decreasing LC03. Using logistic regression, an association was observed between mortality and lactate at H3 with an odds ratio (OR) of 1.21 (95% confidence interval (CI) 1.05-1.42); LC03, OR of 0.93 (95% CI 0.87-0.99) and LC06, OR of 0.96 (95% CI 0.92-0.99). CONCLUSION Blood lactate and LC within the first 3 h of ECLS in refractory CA are associated with mortality. LC is a more relevant parameter than blood lactate, taking into account both the production and elimination of lactate. We suggest to preferentially use LC to assess the patient's outcome.
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Affiliation(s)
- Romain Jouffroy
- Departments of Anaesthesia and Intensive Care Unit, SAMU, Hôpital Universitaire Necker - Enfants Malades, Université Paris Descartes, Paris, France
| | - Anastasia Saade
- Departments of Anaesthesia and Intensive Care Unit, SAMU, Hôpital Universitaire Necker - Enfants Malades, Université Paris Descartes, Paris, France
| | - Pascal Philippe
- Departments of Anaesthesia and Intensive Care Unit, SAMU, Hôpital Universitaire Necker - Enfants Malades, Université Paris Descartes, Paris, France
| | - Pierre Carli
- Departments of Anaesthesia and Intensive Care Unit, SAMU, Hôpital Universitaire Necker - Enfants Malades, Université Paris Descartes, Paris, France
| | - Benoit Vivien
- Departments of Anaesthesia and Intensive Care Unit, SAMU, Hôpital Universitaire Necker - Enfants Malades, Université Paris Descartes, Paris, France
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Early Risk Score for Predicting Hypotension in Normotensive Patients with Non-Variceal Upper Gastrointestinal Bleedin. J Clin Med 2019; 8:jcm8010037. [PMID: 30609708 PMCID: PMC6352164 DOI: 10.3390/jcm8010037] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2018] [Revised: 12/24/2018] [Accepted: 12/26/2018] [Indexed: 12/25/2022] Open
Abstract
Risk assessment for upper gastrointestinal bleeding (UGIB) is important; however, current scoring systems are insufficient. We aimed to develop and validate a prediction model for rapidly determining the occurrence of hypotension in non-variceal UGIB patients with normotension (systolic blood pressure ≥90 mmHg) at emergency department presentation. In this prospective observational cohort study, consecutive non-variceal UGIB patients between January 2012 and April 2017 were enrolled. We developed and validated a new prediction model through logistic regression, with the occurrence of hypotension <24 h as the primary outcome. Among 3363 UGIB patients, 1439 non-variceal UGIB patients were included. The risk factors for the occurrence of hypotension were lactate level, blood in nasogastric tube, and systolic blood pressure. The area under the curve (AUC) of the new scoring model (LBS—Lactate, Blood in nasogastric tube, Systolic blood pressure) in the development cohort was 0.74, higher than the value of 0.64 of the Glasgow–Blatchford score for predicting the occurrence of hypotension. The AUC of the LBS score in the validation cohort was 0.83. An LBS score of ≤2 had a negative predictive value of 99.5% and an LBS score of ≥7 had a specificity of 97.5% in the validation cohort. The new LBS score stratifies normotensive patients with non-variceal UGIB at risk for developing hypotension.
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Wentling J, Krall SP, McNierney A, Dewey K, Richman PB, Blow O. Predictive Value of Point-of-care Lactate Measurement in Patients Meeting Level II and III Trauma Team Activation Criteria that Present to the Emergency Department: A Prospective Study. J Emerg Trauma Shock 2019; 12:203-208. [PMID: 31543644 PMCID: PMC6735203 DOI: 10.4103/jets.jets_120_18] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Background The aim of this study was to investigate the utility of early point-of-care (POC) lactate levels to help predict injury severity and ultimate emergency department (ED) disposition for trauma patients meeting Level II and III activation criteria. Methods This was a blinded, prospective cohort study including a convenience sample of patients meeting our triage criteria for Level II or III team activation with stable vital signs. Bedside lactate samples were collected during the secondary survey. Clinical care/disposition was at the discretion of physicians who remained blinded to the bedside lactate result. An elevated lactate was defined as >2.0 mmol/L. Results Ninety-six patients were in the study group; mean age was 41 ± 17 years, 26% were female, 57% were Hispanic, and 60% admitted. We found no difference in initial mean POC lactate levels (mmol/L) for admitted versus discharged groups and Injury Severity Score (ISS) ≥9 versus ISS <9 groups (3.71 [95% confidence interval (CI): 3.1-4.4] vs. 3.85 [95% CI: 2.8-4.9]; P = 0.99 and 3.54 [95% CI: 2.7-4.4] vs. 3.89 [95% CI: 3.1-4.6]; P = 0.60, respectively). Performance characteristics of early elevated lactate levels were poor both to predict need for hospital admission (sensitivity = 77% [65%-87%]; specificity = 26% [13%-43%]; negative predictive value [NPV] = 43% [27%-61%]; and positive predictive value [PPV] = 62% [56%-67%]) and to identify patients with ISS scores ≥9 (sensitivity = 76% [59%-89%]; specificity = 24% [14%-37%]; NPV = 65% [47%-80%]; and PPV = 36% [30%-41%]). Conclusions For Level II/III, we found that early bedside lactate levels were not predictive of ISS ≥9 or the need for admission. Level of Evidence III (diagnostic test).
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Affiliation(s)
- Jessica Wentling
- Department of Emergency Medicine, CHRISTUS Health/Texas A and M Health Science Center, Corpus Christi, TX, USA
| | - Scott P Krall
- Department of Emergency Medicine, CHRISTUS Health/Texas A and M Health Science Center, Corpus Christi, TX, USA
| | - Afton McNierney
- Department of Emergency Medicine, CHRISTUS Health/Texas A and M Health Science Center, Corpus Christi, TX, USA
| | - Kelly Dewey
- Department of Emergency Medicine, CHRISTUS Health/Texas A and M Health Science Center, Corpus Christi, TX, USA
| | - Peter B Richman
- Department of Emergency Medicine, CHRISTUS Health/Texas A and M Health Science Center, Corpus Christi, TX, USA
| | - Osbert Blow
- Department of Acute Care Surgery, Trauma and Surgical Critical Care, Christus Spohn Hospital, Corpus Christi, TX, USA
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Altunbas E, Omercikoglu S, Akoglu H, Denizbasi A. Prognostic value of 2-hour lactate level and lactate clearance for 30-day mortality and comparison with trauma scores in multi-trauma patients. Pak J Med Sci 2018; 34:676-681. [PMID: 30034438 PMCID: PMC6041534 DOI: 10.12669/pjms.343.14294] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Objective: Trauma scores are prone to misreading. Therefore, a readily available, objective way to estimate the mortality of the trauma patients is needed. We aimed to evaluate the prognostic utility of lactate levels, and clearance for 30-days mortality, and compare with the physiological trauma scores. Methods: All adult trauma patients (two hundred) admitted to ED were enrolled. Initial and 2-hour serum lactate levels were measured and components of GAP, MGAP, RTS, VIEWS and VIEWS-L trauma scores were calculated. Results: Final study population was 200 patients with a median age of 33 years. Mortality was 7/200 (3.5%) in 30-days. Both initial (2.3 vs. 7.7 mmol/L) and 2h-lactate (1.7 vs. 8.4 mmol/L) levels were significantly lower, and lactate clearance was significantly higher (23.8% vs. -12.0%) in survivors. Also, the change in the lactate level from 0h to 2h (2.3 vs. 1.7mmol/L) was significant in survivors, contrary to non-survivors (7.7 vs. 8.4mmol/L). VIEWS-L, VIEWS, two hour-lactate level and EMTRAS showed high specificity at the 100% sensitivity cut-offs, therefore, were the most valuable prognostic parameters in this study. Conclusion: Calculation of 2h-lactate clearance and evaluation of a 2h-lactate level may not be needed to predict long-term mortality if the initial lactate level is below 2.8mmol/L.
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Affiliation(s)
- Erhan Altunbas
- Erhan Altunbas, MD. Department of Emergency Medicine, Atasehir Acibadem Surgery Health Care Center, Istanbul, Turkey. Department of Emergency Medicine, Marmara University Faculty of Medicine, Pendik Education and Research Hospital, Istanbul, Turkey
| | - Serhad Omercikoglu
- Serhad Omercikoglu, MD. Department of Emergency Medicine, Marmara University Faculty of Medicine, Pendik Education and Research Hospital, Istanbul, Turkey
| | - Haldun Akoglu
- Haldun Akoglu, MD. Associate Professor, Department of Emergency Medicine, Marmara University Faculty of Medicine, Pendik Education and Research Hospital, Istanbul, Turkey
| | - Arzu Denizbasi
- Prof. Arzu Denizbasi, MD, PhD. Department of Emergency Medicine, Marmara University Faculty of Medicine, Pendik Education and Research Hospital, Istanbul, Turkey
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Baron BJ, Nguyen A, Stefanov D, Shetty A, Zehtabchi S. Clinical value of triage lactate in risk stratifying trauma patients using interval likelihood ratios. Am J Emerg Med 2017; 36:784-788. [PMID: 29032876 DOI: 10.1016/j.ajem.2017.10.015] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2017] [Accepted: 10/07/2017] [Indexed: 10/18/2022] Open
Abstract
Emergency physicians face the challenge of rapidly identifying high-risk trauma patients. Lactate (LAC) is widely used as a surrogate of tissue hypoperfusion. However, clinically important values for LAC as a predictor of mortality are not well defined. OBJECTIVES 1. To assess the value of triage LAC in predicting mortality after trauma. 2. To compute interval likelihood ratios (LR) for LAC. METHODS Retrospective chart review of trauma patients with a significant injury mechanism that warranted labs at an urban trauma center. OUTCOME In-hospital mortality. Data are presented as median and quartiles or percentages with 95% confidence intervals. Groups (lived vs. died) were compared with Man-Whitney-U or Fisher's-exact test. Multivariate analysis was used to measure the association of the independent variables and mortality. The interval likelihood ratios were calculated for all LAC observed values. RESULTS 10,575 patients; median age: 38 [25-57]; 69% male; 76% blunt; 1.1% [n=119] mortality. LAC was statistically different between groups in univariate (2.3 [1.6,3.0] vs 2.8 [1.6,4.8], p=0.008) and multivariate analyses (odds ratio: 1.14 [1.08-1.21], p=0.0001). Interval ratios for LR- ranged from 0.6-1.0. Increasing LAC increased LR+. However, LR+ for LAC reached 5 with LAC>9mmol/L and passed 10 (moderate and conclusive increase in disease probability, respectively) with LAC>18mmol/L. CONCLUSIONS In a cohort of trauma patients with a wide spectrum of characteristics triage LAC was statistically able to identify patients at high risk of mortality. However, clinically meaningful contribution to decision-making occurred only at LAC>9. LAC was not useful at excluding those with a low risk of mortality.
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Affiliation(s)
- Bonny J Baron
- Department of Emergency Medicine, State University of New York, Downstate Medical Center and Kings County Hospital, Brooklyn, NY, USA
| | - Andrew Nguyen
- Department of Emergency Medicine, State University of New York, Downstate Medical Center and Kings County Hospital, Brooklyn, NY, USA
| | - Dimitre Stefanov
- Research Division, Statistical Design & Analysis, State University of New York, Downstate Medical Center, Brooklyn, NY, USA
| | - Amit Shetty
- Department of Emergency Medicine, State University of New York, Downstate Medical Center and Kings County Hospital, Brooklyn, NY, USA
| | - Shahriar Zehtabchi
- Department of Emergency Medicine, State University of New York, Downstate Medical Center and Kings County Hospital, Brooklyn, NY, USA.
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Jang HN, Park HO, Yang TW, Yang JH, Kim SH, Moon SH, Byun JH, Lee CE, Kim JW, Kang DH, Baek KH. Biochemical Markers as Predictors of In-Hospital Mortality in Patients with Severe Trauma: A Retrospective Cohort Study. Korean J Crit Care Med 2017; 32:240-246. [PMID: 31723642 PMCID: PMC6786731 DOI: 10.4266/kjccm.2017.00360] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2017] [Revised: 07/27/2017] [Accepted: 08/01/2017] [Indexed: 12/04/2022] Open
Abstract
Background Initial evaluation of injury severity in trauma patients is an important and challenging task. We aimed to assess whether easily measurable biochemical parameters (hemoglobin, pH, and prothrombin time/international normalized ratio [PT/INR]) can predict in-hospital mortality in patients with severe trauma. Methods This retrospective study involved review of the medical records of 315 patients with severe trauma and an injury severity score >15 who were managed at Gyeongsang National University Hospital between January 2005 and December 2015. We extracted the following data: in-hospital mortality, injury severity score, and initial hemoglobin level, pH, and PT/INR. The predictive values of these variables were compared using receiver operation characteristic curves. Results Of the 315 patients, 72 (22.9%) died. The in-hospital mortality rates of patients with hemoglobin levels <8.4 g/dl and ≥8.4 g/dl were 49.8% and 9.9%, respectively (P < 0.001). At a cutoff hemoglobin level of 8.4 g/dl, the sensitivity and specificity values for mortality were 81.9% and 86.4%, respectively. At a pH cutoff of 7.25, the sensitivity and specificity values for mortality were 66.7% and 77.8%, respectively; 66.7% of patients with a pH <7.25 died versus 22.2% with a pH ≥7.25 (P < 0.001). The in-hospital mortality rates for patients with PT/INR values ≥1.4 and <1.4 were 37.5% and 16%, respectively (P < 0.001; sensitivity, 37.5%; specificity, 84%). Conclusions Using the suggested cutoff values, hemoglobin level, pH, and PT/INR can simply and easily be used to predict in-hospital mortality in patients with severe trauma.
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Affiliation(s)
- Ha Nee Jang
- Department of Internal Medicine, Gyeongsang National University Hospital, Gyeongsang National University School of Medicine and Institute of Health Sciences, Jinju, Korea
| | - Hyun Oh Park
- Department of Thoracic and Cardiovascular Surgery, Gyeongsang National University Changwon Hospital, Gyeongsang National University School of Medicine and Institute of Health Sciences, Changwon, Korea
| | - Tae Won Yang
- Department of Neurology, Gyeongsang National University Changwon Hospital, Changwon, Korea
| | - Jun Ho Yang
- Department of Thoracic and Cardiovascular Surgery, Gyeongsang National University Hospital, Gyeongsang National University School of Medicine and Institute of Health Sciences, Jinju, Korea
| | - Sung Hwan Kim
- Department of Thoracic and Cardiovascular Surgery, Gyeongsang National University Changwon Hospital, Gyeongsang National University School of Medicine and Institute of Health Sciences, Changwon, Korea
| | - Seong Ho Moon
- Department of Thoracic and Cardiovascular Surgery, Gyeongsang National University Changwon Hospital, Gyeongsang National University School of Medicine and Institute of Health Sciences, Changwon, Korea
| | - Joung Hun Byun
- Department of Thoracic and Cardiovascular Surgery, Gyeongsang National University Changwon Hospital, Gyeongsang National University School of Medicine and Institute of Health Sciences, Changwon, Korea
| | - Chung Eun Lee
- Department of Thoracic and Cardiovascular Surgery, Gyeongsang National University Hospital, Gyeongsang National University School of Medicine and Institute of Health Sciences, Jinju, Korea
| | - Jong Woo Kim
- Department of Thoracic and Cardiovascular Surgery, Gyeongsang National University Changwon Hospital, Gyeongsang National University School of Medicine and Institute of Health Sciences, Changwon, Korea
| | - Dong Hun Kang
- Department of Thoracic and Cardiovascular Surgery, Gyeongsang National University Hospital, Gyeongsang National University School of Medicine and Institute of Health Sciences, Jinju, Korea
| | - Kyeong Hee Baek
- Department of Neurosurgery, Gyeongsang National University Changwon Hospital, Changwon, Korea
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Andersson A, Chen Q, Groop L, Bülow L, Xie B. Continuous and simultaneous determination of venous blood metabolites. Talanta 2017; 171:270-274. [PMID: 28551140 DOI: 10.1016/j.talanta.2017.05.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2017] [Revised: 04/30/2017] [Accepted: 05/04/2017] [Indexed: 01/04/2023]
Abstract
Metabolic syndrome is associated with cardiovascular disease, type 2 diabetes mellitus (T2DM) and prediabetes. Metabolic syndrome is a cluster of interrelated clinical disorders. Difficulties in regulating glucose levels in blood are implicated in many of these disorders. Lactate, another energy metabolite, is produced under anaerobic conditions and can be used to monitor the balance between aerobic and anaerobic metabolism. Tested together, these metabolite levels can provide pro-diagnostic information that improves patient outcomes. Glucose and lactate were determined continuously and simultaneously in whole blood using a dual-channel thermal biosensor device in which one channel employed glucose oxidase for glucose analysis in comparison with lactate oxidase for lactate analysis in the others. No detectable clogging or interference was observed using venous blood samples. The linear detection range for both the glucose and lactate assays was 0.5-45mM. The sampling rate of up to 24 samples per hour with assay cycle time of 2.5min was achieved. Comparative analysis between our device and the HemoCue method showed an excellent correlation. The device was stable for hundreds of injections over a period of 45 days. The broad linear range, fast response and detection sensitivity are satisfactory for the clinical requirements, e.g. for diabetic or cardiovascular patients in intensive care units or surgical operation, where the tight control of blood glucose can decrease morbidity or mortality.
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Affiliation(s)
- Anneli Andersson
- Department of Pure and Applied Biochemistry, Lund University, P.O. Box 124, SE-22100 Lund, Sweden
| | - Qun Chen
- Department of Pure and Applied Biochemistry, Lund University, P.O. Box 124, SE-22100 Lund, Sweden
| | - Leif Groop
- Department of Clinical Sciences, Diabetes and Endocrinology, Lund University, SE-20502 Malmö, Sweden
| | - Leif Bülow
- Department of Pure and Applied Biochemistry, Lund University, P.O. Box 124, SE-22100 Lund, Sweden
| | - Bin Xie
- Department of Pure and Applied Biochemistry, Lund University, P.O. Box 124, SE-22100 Lund, Sweden.
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Umebachi R, Taira T, Wakai S, Aoki H, Otsuka H, Nakagawa Y, Inokuchi S. Measurement of blood lactate, D-dimer, and activated prothrombin time improves prediction of in-hospital mortality in adults blunt trauma. Am J Emerg Med 2017; 36:370-375. [PMID: 28869098 DOI: 10.1016/j.ajem.2017.08.025] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2017] [Accepted: 08/11/2017] [Indexed: 12/27/2022] Open
Affiliation(s)
- Rimako Umebachi
- Department of Emergency and Critical Care Medicine, Tokai University School of Medicine, Japan.
| | - Takayuki Taira
- Department of Emergency and Critical Care Medicine, Tokai University School of Medicine, Japan
| | - Shinjiro Wakai
- Department of Emergency and Critical Care Medicine, Tokai University School of Medicine, Japan
| | - Hiromichi Aoki
- Department of Emergency and Critical Care Medicine, Tokai University School of Medicine, Japan
| | - Hiroyuki Otsuka
- Department of Emergency and Critical Care Medicine, Tokai University School of Medicine, Japan
| | - Yoshihide Nakagawa
- Department of Emergency and Critical Care Medicine, Tokai University School of Medicine, Japan
| | - Sadaki Inokuchi
- Department of Emergency and Critical Care Medicine, Tokai University School of Medicine, Japan
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Agreement between arterial and venous lactate in emergency department patients: a prospective study of 157 consecutive patients. Eur J Emerg Med 2016; 25:92-96. [PMID: 27879535 DOI: 10.1097/mej.0000000000000435] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
INTRODUCTION In the emergency department (ED), lactate is routinely used for risk stratification. Whether venous or arterial lactate measured on blood gas is interchangeable is not known. We hypothesized that venous lactate can be used instead of arterial lactate for the evaluation of acute patients in the ED. PATIENTS AND METHODS This was a prospective single-center study. All patients requiring a lactate measurement were enrolled and we simultaneously drew arterial and venous blood. We followed up all patients to hospital discharge. Our primary aim was to evaluate agreements between the two measurements using Bland and Altman plots with the report of bias (mean difference) and limits of agreements. We also aimed to determine the rate of misclassification (defined as one measurement<1.8 mmol/l and the other>2.2). Our secondary aim was to evaluate their respective prognostic value to predict in-hospital death or admission in the ICU longer than 72 h. RESULTS The mean age of the 132 analyzed patients was 62 years (SD: 18 years), and 59% were men. The mean difference (bias) between arterial and venous lactate was -0.6 mmol/l (limits of agreement: -1.7 to 0.6 mmol/l). The rate of misclassification was 8% (95% confidence interval: 3-2%). Both methods present similar performances for the prediction of poor outcomes, with an area under the receiving operator characteristic curves of 0.67 for both. Results were similar when focused only on septic patients. CONCLUSION Venous and arterial lactates do not agree well, and there is a high misclassification rate. Venous lactate does not appear to be interchangeable with arterial sampling.
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Do lactate levels in the emergency department predict outcome in adult trauma patients? A systematic review. J Trauma Acute Care Surg 2016; 81:555-66. [DOI: 10.1097/ta.0000000000001156] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Abstract
Trauma patients require early assessment of injury severity. Trauma scores, although well validated, can be unwieldy in the emergency clinical setting. We sought to evaluate the prognostic value of initial serum lactate (ISL) for mortality, operative intervention (OI), and intensive care unit admission (ICUA) in trauma patients. We conducted an institutional review board-approved retrospective study. We reviewed all trauma patients between January 2007 and June 2012 in our prospectively maintained database. We included only adults whose ISL had been drawn within the first 35 min after arrival. We included only those patients whose interval between injury and arrival was within 24 h. Survivors and nonsurvivors were compared using logistic regression, Mann-Whitney U, and chi-square tests. Discriminating ability of ISL for mortality was assessed with receiver operating characteristic analysis. Our secondary outcomes (ICUA and OI) were evaluated with logistic regression test and receiver operating characteristic analysis. A total of 1,941 patients were included. Overall mortality was 6.2%. Median ISL was 32 mg/dL (interquartile range, 17 - 62) for nonsurvivors versus 21 mg/dL (interquartile range, 14 - 32) for survivors (P < 0.001). In multivariate analysis, ISL was a significant covariate for mortality (P = 0.015). The odds ratio was 1.010 (95% confidence interval, 1.002 - 1.019). The area under the curve was 0.63. The ISL was a significant covariate for OI (P = 0.033). The ISL did not reach significance for ICUA. The ISL is an easily measured, rapid, and inexpensive test that can help to quickly stratify injury severity in trauma patients. We have found that ISL, when used in strictly selected patients, can predict OI and mortality.
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Okeny PK, Ongom P, Kituuka O. Serum interleukin-6 level as an early marker of injury severity in trauma patients in an urban low-income setting: a cross-sectional study. BMC Emerg Med 2015; 15:22. [PMID: 26376825 PMCID: PMC4574191 DOI: 10.1186/s12873-015-0048-z] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2014] [Accepted: 09/10/2015] [Indexed: 12/03/2022] Open
Abstract
Background Trauma is still the leading cause of death in many regions of the world. Severity scores have been developed to assist in management of trauma victims. Immune response to trauma has been known to positively correspond to the severity of trauma. Part of this response involves release of cytokines into blood circulation which promote the acute inflammatory response commonly seen after trauma. Studies have shown that IL-6 levels commonly correlate positively with the Injury Severity Score (ISS). The aim of this cross-sectional study was to determine whether this kind of relationship exists between IL-6 levels and injury severity in trauma patients in Mulago Hospital as defined by the Kampala Trauma Score (KTSII) which is locally developed. Methods Trauma patients aged ≥18 years presenting to the Accident and Emergency unit of Mulago National Referral Hospital (MNRH) within 12 h after injury were recruited into the study after obtaining consent. Severity of injury was determined as per the Kampala Trauma Score (KTSII) and venous blood drawn for assay of serum IL-6 levels. Data obtained was entered and analyzed using Stata version 11 software focusing on the association between Serum IL-6 levels with Severity of trauma and duration of injury. Results A total of 159 patients were recruited (79 Mild and 80 Severe trauma) with a male to female ratio of 4.7:1. Road traffic crashes (67.92 %) were the commonest cause of injury. Serum IL-6 levels were found to positively correspond with severity of injury (z = 4.718, p < 0.001). There was no significant correlation between serum IL-6 levels and duration of injury in both severe (r = 0.12, p = 0.29) and mild (r = 0.06, p = 0.62) trauma groups of patients. Only 9.43 % of trauma patients were brought in an Ambulance. Conclusions Serum IL-6 levels correspond with severity of injury. However, within the first twelve hours after injury, these levels did not vary significantly with duration of injury.
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Affiliation(s)
- Paul K Okeny
- Department of Surgery, Gulu Regional Referral and Teaching Hospital, P.O Box 160, Gulu, Uganda.
| | - Peter Ongom
- Department of Surgery, College of Health Sciences, Makerere University, Mulago Hill road, P.O Box 7072, Kampala, Uganda.
| | - Olivia Kituuka
- Department of Surgery, College of Health Sciences, Makerere University, Mulago Hill road, P.O Box 7072, Kampala, Uganda.
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Ay N, Alp V, Aliosmanoğlu İ, Sevük U, Kaya Ş, Dinç B. Factors affecting morbidity and mortality in traumatic colorectal injuries and reliability and validity of trauma scoring systems. World J Emerg Surg 2015; 10:21. [PMID: 26023317 PMCID: PMC4446804 DOI: 10.1186/s13017-015-0014-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2014] [Accepted: 04/30/2015] [Indexed: 12/26/2022] Open
Abstract
Background and aim This study aims to determine the factors that affect morbidity and mortality in colon and rectum injuries related with trauma, the use of trauma scoring systems in predicting mortality and morbidity. Patients and methods Besides patient demographic characteristics, the mechanism of injury, the time between injury and surgery, accompanying body injuries, admittance Glasgow coma scale (GCS), findings at surgery and treatment methods were also recorded. With the obtained data, the abbreviated injury scale (AIS), injury severity score (ISS), revised trauma score (RTS) and trauma-ISS (TRISS) scores of each patient were calculated by using the 2008 revised AIS. Results Of the patients, 172 (88.7 %) were male, 22 (11.3 %) were female and the mean age was 29.15 ± 12.392 (15–89) years. The morbidity of our patients were 32 % and mortality were 12.4 %. ISS (p < 0.001), RTS (p < 0.001), and the TRISS (p < 0.001) on mortality were found to be significant. TRISS (p = 0.008), the ISS (p < 0.001), the RTS (p = 0.03), the trauma surgery interval (TSI, p < 0.001) were observed to have significant effects on morbidity. Regression analysis showed that the ISS (OR 1.1; CI 95 % 1.01–1.2; p = 0.02), the RTS (OR 0.37; CI 95 % 0.21–0.67; p = 0.001) had significant effects on mortality. While the effects of TSI (OR 5.3; CI 95 % 1.5–18.8; p = 0.01) on morbidity were found to be significant. Conclusion Predicting mortality by using scoring systems and close postoperative follow up of patients in the risk group may ensure decreases in the rates of morbidity and mortality.
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Affiliation(s)
- Nurettin Ay
- Diyarbakır Gazi Yaşargil Education and Research Hospital, Transplantation Center, Diyarbakır, Turkey
| | - Vahhaç Alp
- Department of General Surgery, Diyarbakir Gazi Yaşargil Education and Research Hospital, Diyarbakır, Turkey
| | | | - Utkan Sevük
- Department of Cardiovascular Surgery, Diyarbakır Gazi Yaşargil Education and Research Hospital, Diyarbakır, Turkey
| | - Şafak Kaya
- Department of İnfectious Disease, Diyarbakır Gazi Yaşargil Education and Research Hospital, Diyarbakır, Turkey
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Ramanathan R, Parrish DW, Hartwich JE, Haynes JH. Utility of admission serum lactate in pediatric trauma. J Pediatr Surg 2015; 50:598-603. [PMID: 25840070 DOI: 10.1016/j.jpedsurg.2014.08.013] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2014] [Revised: 07/18/2014] [Accepted: 08/13/2014] [Indexed: 11/16/2022]
Abstract
BACKGROUND/PURPOSE Serum lactate measurement has a predictive value in adult trauma. To date, there has been no prospective analysis of the predictive value of admission serum lactate in pediatric trauma. METHODS Admission serum lactate was prospectively measured over a two year period on all children under age 15 years who met trauma alert criteria at an urban Level 1 trauma center. Elevated serum lactate (>2.0 mmol/L) was correlated with Injury Severity Scores (ISS), injury types, and hospital outcomes. RESULTS A total of 277 injured children with admission lactate measurements were evaluated. Patients with elevated lactate had higher mean ISS than those with normal lactate (12.8 vs. 5.1, p<0.01), and increased need for intubation, major procedures and ICU admission. Elevated lactate was associated with low specificity (54.4%), moderate sensitivity (86.7%) and high negative predictive value (94.5%) for detecting injury (ISS>15). Lactate measurements over 4.7 mmol/L were highly specific (95.8%) for injury. CONCLUSIONS Elevated admission venous lactate level is associated with injury and outcomes, but lacks adequate sensitivity and specificity. Lactate over 4.7 mmol/L is strongly suggestive of severe injury, while lactate below 2.0 mmol/L is reassuring for not having injury. Lactates between 2.0 and 4.7 mmol/L remain indeterminate in predictive potential for injury or outcomes.
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Affiliation(s)
- Rajesh Ramanathan
- Department of Surgery, Virginia Commonwealth University Medical Center, Richmond, VA 23298, United States.
| | - Dan W Parrish
- Department of Surgery, Virginia Commonwealth University Medical Center, Richmond, VA 3298, United States.
| | - Joseph E Hartwich
- Department of Surgery, Brown University, Providence, RI 02903, United States.
| | - Jeffrey H Haynes
- Children's Hospital of Richmond, Virginia Commonwealth University Health System, 1200 East Broad Street, P.O. Box 980015, Richmond, VA 23298, United States.
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Duranteau J, Asehnoune K, Pierre S, Ozier Y, Leone M, Lefrant JY. Recommandations sur la réanimation du choc hémorragique. ANESTHESIE & REANIMATION 2015. [DOI: 10.1016/j.anrea.2014.12.007] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
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Langlois I, Planché A, Boysen SR, Abeysekara S, Zello GA. Blood concentrations of d
- and l
-lactate in healthy rabbits. J Small Anim Pract 2014; 55:451-6. [DOI: 10.1111/jsap.12247] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2013] [Revised: 04/14/2014] [Accepted: 05/26/2014] [Indexed: 11/27/2022]
Affiliation(s)
- I. Langlois
- Department of Clinical Sciences, Faculté de Médecine Vétérinaire; Université de Montréal; Saint-Hyacinthe Québec J2S 2M2 Canada
| | - A. Planché
- Department of Clinical Sciences, Faculté de Médecine Vétérinaire; Université de Montréal; Saint-Hyacinthe Québec J2S 2M2 Canada
| | - S. R. Boysen
- Department of Clinical Sciences, Faculté de Médecine Vétérinaire; Université de Montréal; Saint-Hyacinthe Québec J2S 2M2 Canada
- Department of Veterinary Clinical and Diagnostic Sciences; Faculty of Veterinary Medicine University of Calgary; Calgary Alberta T2N 4N1 Canada
| | - S. Abeysekara
- College of Pharmacy & Nutrition; University of Saskatchewan; Saskatoon Saskatchewan S7N 5C9 Canada
| | - G. A. Zello
- College of Pharmacy & Nutrition; University of Saskatchewan; Saskatoon Saskatchewan S7N 5C9 Canada
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Okello M, Makobore P, Wangoda R, Upoki A, Galukande M. Serum lactate as a predictor of early outcomes among trauma patients in Uganda. Int J Emerg Med 2014; 7:20. [PMID: 25097669 PMCID: PMC4105872 DOI: 10.1186/s12245-014-0020-9] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2014] [Accepted: 05/16/2014] [Indexed: 11/25/2022] Open
Abstract
Background Trauma is the leading cause of death in the developed world. Accurate assessment of severity of injuries is critical in informing treatment choices. Current models of assessing severity of injury are not without limitations. The objective of this study therefore was to determine the diagnostic accuracy of serum lactate assays in assessing injury severity and prediction of early outcomes among trauma patients. Methods This was a cross-sectional analytical study. Consecutive series of all eligible patients had a single venous blood sample drawn for lactate assay analysis (index test) and a concurrent Kampala Trauma Score (KTS) II value determination (reference test). Admitted patients were followed up to assess early outcomes (length of hospital stay and mortality). Results Out of the 502 trauma patients recruited, 108 (22%) were severely injured, 394 (78%) had non-severe injuries, and 183 were admitted. There was a significant difference between median (interquartile range (IQR)) lactate levels among the severely injured (4.3 (2.6, 6.6)) and the non-severely injured (2.4 (1.6, 3.5), p < 0.001). After a 72-h follow-up of the admitted patients, 102 (56%) were discharged, 61 (33%) remained in the hospital, 3 (2%) remained in the ICU, and 17 (3%) had died. The area under the receiver operator characteristic (ROC) curve was 0.75 for injury severity. Serum lactate ≥2.0 mmol/l had a hazard ratio of 1.10 (p < 0.001) for emergency department disposition, 4.33 (p = 0.06) for the 72-h non-discharge disposition, and 1.19 (p < 0.001) for 72-h mortality. Serum lactate ≥2.0 mmol/l at admission was useful in discriminating severe from non-severe injuries with a sensitivity of 88%, specificity of 38%, PPV of 30%, and NPV of 92%. Conclusion Hyperlactatemia in an emergency trauma patient suggests a high probability of severe injury.
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Affiliation(s)
- Michael Okello
- Department of Human Anatomy, Makerere University College of Health Sciences, Kampala, Uganda
| | - Patson Makobore
- Department of Surgery, Makerere University College of Health Sciences, Kampala, Uganda
| | - Robert Wangoda
- Accident and Emergency Department, Mulago National Referral Hospital, Kampala, Uganda
| | - Alex Upoki
- Department of Surgery, Mulago National Referral Hospital, Kampala, Uganda
| | - Moses Galukande
- Department of Surgery, Makerere University College of Health Sciences, Kampala, Uganda
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Bloom B, Pott J, Freund Y, Grundlingh J, Harris T. The agreement between abnormal venous lactate and arterial lactate in the ED: a retrospective chart review. Am J Emerg Med 2014; 32:596-600. [DOI: 10.1016/j.ajem.2014.03.007] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2014] [Revised: 03/07/2014] [Accepted: 03/07/2014] [Indexed: 10/25/2022] Open
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Abassi ZA, Okun-Gurevich M, Abu Salah N, Awad H, Mandel Y, Campino G, Mahajna A, Feuerstein GZ, Fitzpatrick M, Hoffman A, Winaver J. Potential early predictors for outcomes of experimental hemorrhagic shock induced by uncontrolled internal bleeding in rats. PLoS One 2013; 8:e80862. [PMID: 24303027 PMCID: PMC3841163 DOI: 10.1371/journal.pone.0080862] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2013] [Accepted: 10/17/2013] [Indexed: 12/14/2022] Open
Abstract
Uncontrolled hemorrhage, resulting from traumatic injuries, continues to be the leading cause of death in civilian and military environments. Hemorrhagic deaths usually occur within the first 6 hours of admission to hospital; therefore, early prehospital identification of patients who are at risk for developing shock may improve survival. The aims of the current study were: 1. To establish and characterize a unique model of uncontrolled internal hemorrhage induced by massive renal injury (MRI), of different degrees (20-35% unilateral nephrectomy) in rats, 2. To identify early biomarkers those best predict the outcome of severe internal hemorrhage. For this purpose, male Sprague Dawley rats were anesthetized and cannulas were inserted into the trachea and carotid artery. After abdominal laparotomy, the lower pole of the kidney was excised. During 120 minutes, hematocrit, pO2, pCO2, base excess, potassium, lactate and glucose were measured from blood samples, and mean arterial pressure (MAP) was measured through arterial tracing. After 120 minutes, blood loss was determined. Statistical prediction models of mortality and amount of blood loss were performed. In this model, the lowest blood loss and mortality rate were observed in the group with 20% nephrectomy. Escalation of the extent of nephrectomy to 25% and 30% significantly increased blood loss and mortality rate. Two phases of hemodynamic and biochemical response to MRI were noticed: the primary phase, occurring during the first 15 minutes after injury, and the secondary phase, beginning 30 minutes after the induction of bleeding. A Significant correlation between early blood loss and mean arterial pressure (MAP) decrements and survival were noted. Our data also indicate that prediction of outcome was attainable in the very early stages of blood loss, over the first 15 minutes after the injury, and that blood loss and MAP were the strongest predictors of mortality.
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Affiliation(s)
- Zaid A. Abassi
- Department of Physiology and Biophysics, Faculty of Medicine, Technion, Haifa, Israel
- Research Unit, Rambam Medical Center, Haifa, Israel
- * E-mail:
| | - Marina Okun-Gurevich
- Department of Physiology and Biophysics, Faculty of Medicine, Technion, Haifa, Israel
| | - Niroz Abu Salah
- Department of Physiology and Biophysics, Faculty of Medicine, Technion, Haifa, Israel
| | - Hoda Awad
- Department of Physiology and Biophysics, Faculty of Medicine, Technion, Haifa, Israel
| | - Yossi Mandel
- Israeli Medical Corps, Tel Aviv, Israel
- The Mina & Everard Goodman Faculty of Life Sciences, Bar Ilan University, Ramat Gan, Israel
| | | | - Ahmad Mahajna
- Department of General Surgery, Rambam Medical Center, Haifa, Israel
| | | | | | - Aaron Hoffman
- Department of Vascular Surgery, Rambam Medical Center, Haifa, Israel
| | - Joseph Winaver
- Department of Physiology and Biophysics, Faculty of Medicine, Technion, Haifa, Israel
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Rishu AH, Khan R, Al-Dorzi HM, Tamim HM, Al-Qahtani S, Al-Ghamdi G, Arabi YM. Even mild hyperlactatemia is associated with increased mortality in critically ill patients. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2013; 17:R197. [PMID: 24025259 PMCID: PMC4056896 DOI: 10.1186/cc12891] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/16/2013] [Accepted: 09/11/2013] [Indexed: 01/20/2023]
Abstract
Introduction The clinical significance of elevation of lactate levels within the reference range is not well studied. The objective of this study was to determine the best cutoff threshold for serum lactate within the reference range (0.01 to 2.00 mM) that best discriminated between survivors and nonsurvivors of critical illness and to examine the association between relative hyperlactatemia (lactate above the identified threshold) and mortality. Methods This was a retrospective cohort study of adult patients admitted to the medical-surgical intensive care unit (ICU) of a tertiary care academic center. Youden index was calculated to identify the best lactate cutoff threshold that discriminated between survivors and nonsurvivors. Patients with lactate above the identified threshold were defined as having relative hyperlactatemia. Multivariate logistic regression, adjusting for baseline variables, was performed to determine the relationship between the above two ranges of lactate levels and mortality. In addition, a test of interaction was performed to assess the effect of selected subgroups on the association between relative hyperlactatemia and hospital mortality. Results During the study period, 2,157 patients were included in the study with mean lactate of 1.3 ± 0.4 mM, age of 55.1 ± 20.3 years, and acute physiology and chronic health evaluation (APACHE) II score of 22.1 ± 8.2. Vasopressors were required in 42.4%. Lactate of 1.35 mM was found to be the best cutoff threshold for the whole cohort. Relative hyperlactatemia was associated with increased hospital mortality (adjusted odds ratio (aOR), 1.60, 95% confidence interval (CI) 1.29 to 1.98), and ICU mortality (aOR, 1.66; 95% CI, 1.26 to 2.17) compared with a lactate level of 0.01 to 1.35 mM. This association was consistent among all examined subgroups. Conclusions Relative hyperlactatemia (lactate of 1.36 to 2.00 mM) within the first 24 hours of ICU admission is an independent predictor of hospital and ICU mortality in critically ill patients.
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Tohira H, Jacobs I, Mountain D, Gibson N, Yeo A. Systematic review of predictive performance of injury severity scoring tools. Scand J Trauma Resusc Emerg Med 2012; 20:63. [PMID: 22964071 PMCID: PMC3511252 DOI: 10.1186/1757-7241-20-63] [Citation(s) in RCA: 93] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2012] [Accepted: 08/28/2012] [Indexed: 11/16/2022] Open
Abstract
Many injury severity scoring tools have been developed over the past few decades. These tools include the Injury Severity Score (ISS), New ISS (NISS), Trauma and Injury Severity Score (TRISS) and International Classification of Diseases (ICD)-based Injury Severity Score (ICISS). Although many studies have endeavored to determine the ability of these tools to predict the mortality of injured patients, their results have been inconsistent. We conducted a systematic review to summarize the predictive performances of these tools and explore the heterogeneity among studies. We defined a relevant article as any research article that reported the area under the Receiver Operating Characteristic curve as a measure of predictive performance. We conducted an online search using MEDLINE and Embase. We evaluated the quality of each relevant article using a quality assessment questionnaire consisting of 10 questions. The total number of positive answers was reported as the quality score of the study. Meta-analysis was not performed due to the heterogeneity among studies. We identified 64 relevant articles with 157 AUROCs of the tools. The median number of positive answers to the questionnaire was 5, ranging from 2 to 8. Less than half of the relevant studies reported the version of the Abbreviated Injury Scale (AIS) and/or ICD (37.5%). The heterogeneity among the studies could be observed in a broad distribution of crude mortality rates of study data, ranging from 1% to 38%. The NISS was mostly reported to perform better than the ISS when predicting the mortality of blunt trauma patients. The relative performance of the ICSS against the AIS-based tools was inconclusive because of the scarcity of studies. The performance of the ICISS appeared to be unstable because the performance could be altered by the type of formula and survival risk ratios used. In conclusion, high-quality studies were limited. The NISS might perform better in the mortality prediction of blunt injuries than the ISS. Additional studies are required to standardize the derivation of the ICISS and determine the relative performance of the ICISS against the AIS-based tools.
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Affiliation(s)
- Hideo Tohira
- School of Primary, Aboriginal and Rural Health Care, The University of Western Australia, M516 The University of Western Australia, Crawley, WA 6009, Australia.
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Simpson CM, Calori GM, Giannoudis PV. Diabetes and fracture healing: the skeletal effects of diabetic drugs. Expert Opin Drug Saf 2011; 11:215-20. [PMID: 22145960 DOI: 10.1517/14740338.2012.639359] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
INTRODUCTION Over 39,000 diabetic patients are surgically treated for trauma and orthopaedic injuries annually in the UK, yet the effects of diabetic medications on the skeletal system is an under researched and under acknowledged field. AREAS COVERED This review covers all English language novel experimental data reports investigating the effects of the main classes of diabetic drugs on the skeletal system, specifically their effects on fracture healing, located through the literature search engines Medline and Web of Science. EXPERT OPINION Post-surgical gylcaemic control is paramount in insulin-controlled type 1 diabetic patients. Data on pharmacological control compounds used in type 2 diabetes are limited. Reports to date indicate thiazolidinediones to exert anti-osteogenic effects, in contrast to the observed osteogenic effects of biguanides. Ongoing research is desirable to guide future clinical recommendations.
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Affiliation(s)
- Christopher M Simpson
- University of Leeds, Leeds Teaching Hospitals NHS Trust, School of Medicine, Academic Dept. of Trauma and Orthopaedics, Leeds, UK
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Zhou N, Windmiller JR, Valdés-Ramírez G, Zhou M, Halámek J, Katz E, Wang J. Enzyme-based NAND gate for rapid electrochemical screening of traumatic brain injury in serum. Anal Chim Acta 2011; 703:94-100. [PMID: 21843680 DOI: 10.1016/j.aca.2011.07.023] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2011] [Revised: 07/05/2011] [Accepted: 07/12/2011] [Indexed: 11/26/2022]
Abstract
We report on the development of a rapid enzyme logic gate-based electrochemical assay for the assessment of traumatic brain injury (TBI). The concept harnesses a biocatalytic cascade that emulates the functionality of a Boolean NAND gate in order to process relevant physiological parameters in the biochemical domain. The enzymatic backbone ensures that a high-fidelity diagnosis of traumatic brain injury can be tendered in a rapid fashion when the concentrations of key serum-based biomarkers reach pathological levels. The excitatory neurotransmitter glutamate and the enzyme lactate dehydrogenase were used here as clinically-relevant input TBI biomarkers, in connection to the low-potential detection of the NADH product in the presence of methylene green at a glassy carbon electrode. A systematic optimization of the gate and the entire protocol has resulted in the effective discrimination between the physiological and pathological logic levels. Owing to its robust design, the enzyme-based logic gate mitigates potential interferences from both physiological and electroactive sources and is able to perform direct measurements in human serum samples. Granted further detailed clinical validation, this proof-of-concept study demonstrates the potential of the electrochemical assay to aid in the rapid and decentralized diagnosis of TBI.
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Affiliation(s)
- Nandi Zhou
- Department of NanoEngineering, University of California at San Diego, La Jolla, 92093-0448, USA
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