Inclusion of lactate level measured upon emergency room arrival in trauma outcome prediction models improves mortality prediction: a retrospective, single-center study

Observational Analysis of Point-of-Care Lactate Plus™ Meter in Preclinical Trauma Models

BACKGROUND/OBJECTIVES

Blood lactate concentration is often used to assess systemic hypoperfusion, tissue hypoxia, and sepsis in trauma patients and serves as a prognostic indicator and marker of response to therapy. Point-of-care (POC) devices provide rapid lactate measurements with a single drop of blood. In this study, lactate values from whole blood, measured with two POC devices, Abbott i-STAT® and the Nova Biomedical Lactate (LA) Plus™ meter, are compared.

METHODS

An observational analysis of 760 blood samples from four preclinical trauma animal models was performed. Lactate was measured simultaneously with two POC devices (i-STAT® and the Lactate Plus™ meter). The evaluation in the form of a Bland-Altman diagram showed the agreement of the tests.

RESULTS

The Spearman correlation was 0.9180 (95% CI 0.9056 to 0.9288) for i-STAT® vs. the LA Plus™ meter. Both tests showed a significant increase in lactate after injury (p < 0.05). The i-STAT® showed a small bias compared to the LA Plus™ meter (-0.0227 ± 0.4542 with 95% limits of agreement from -0.09129 to 0.8675). The LA Plus™ meter showed slightly higher values overall (0.0227 mmol/L), but the i-STAT® showed higher results at lactate levels above 2.5 mmol/L.

CONCLUSIONS

The observed similarity in performance between the two devices suggests that both are capable of reliably measuring lactate levels in a trauma situation. The LA Plus™ meter provides fast results with only one drop of blood. This study supports the prehospital use of POC devices.

Plasma interleukin responses as predictors of outcome stratification in patients after major trauma: a prospective observational two centre study

Background and objectives

There is a need to develop objective risk stratification tools to define efficient care pathways for trauma patients. Biomarker-based point of care testing may strengthen existing clinical tools currently available for this purpose. The dysregulation of pro- and anti-inflammatory cytokines in the pathogenesis of organ failure is well recognised. This study was carried out to evaluate whether blood concentrations of IL-6, IL-10, and IL-6:IL-10 ratios in the early stages of the illness are significantly different in patients with worsening organ function.

Materials and methods

In this prospective observational cohort study, plasma concentrations of IL-6 and IL-10 on days 1, 3 and 5 were measured in 91 major trauma patients using a multiplexed cytometric bead array approach. A composite measure of adverse outcome - defined as SOFA ≥ 2 or mortality at 7 days, was the primary outcome. IL-6 and IL-10 concentrations in early samples (days 1, 3 & 5) in patients who developed SOFA ≥ 2 on day 7 were compared against those who did not. Similar composite outcome groups at day 5 and in groups with worsening or improving SOFA scores (ΔSOFA) at days 7 and 5 were undertaken as secondary analyses.

Results

Stratification on day 7, 44 (48%) patients showed adverse outcomes. These adverse outcomes associated with significantly greater IL-6 concentrations on days 1 and 5 (Day 1: 47.65 [23.24-78.68] Vs 73.69 [39.93 - 118.07] pg/mL, P = 0.040 and Day 5: 12.85 [5.80-19.51] Vs 28.90 [8.78-74.08] pg/mL; P = 0.0019). Similarly, IL-10 levels were significantly greater in the adverse outcome group on days 3 and 5 (Day 3: 2.54 [1.76-3.19] Vs 3.16 [2.68-4.21] pg/mL; P = 0.044 and Day 5: 2.03 [1.65-2.55] Vs 2.90 [2.00-5.06] pg/mL; P <0.001). IL-6 and IL-10 concentrations were also significantly elevated in the adverse outcome groups at day 3 and day 5 when stratified on day 5 outcomes. Both IL-6 and IL-6:IL-10 were found to be significantly elevated on days 1 and 3 when stratified based on ΔSOFA at day 5. This significance was lost when stratified on day 7 scores.

Conclusions

Early IL-6 and IL-10 concentrations are significantly greater in patients who develop worsening organ functions downstream. These differences may provide an alternate biomarker-based approach to strengthen risk stratification in trauma patients.

Admission Lactate and Base Deficit in Predicting Outcomes of Pediatric Trauma

BACKGROUND

To compare admission lactate and base deficit (BD), which physiologically reflect early hemorrhagic shock, as outcome predictors of pediatric trauma.

METHODS

We reviewed the data of children with trauma who visited a Korean academic hospital from 2010 through 2018. Admission lactate and BD were compared between children with and without primary outcomes. The outcomes included in-hospital mortality, early (≤24 h) transfusion, and early surgical interventions for the torso or major vessels. Subsequently, performances of lactate and BD in predicting the outcomes were compared using receiver operating characteristic curves. Logistic regressions were conducted to identify the independent associations of the two markers with each outcome.

RESULTS

Of the 545 enrolled children, the mortality, transfusion, and surgical interventions occurred in 7.0%, 43.5%, and 14.9%, respectively. Cutoffs of lactate and BD for each outcome were as follows: mortality, 5.1 and 6.7 mmol/L; transfusion, 3.2 and 4.9 mmol/L; and surgical interventions, 2.9 and 5.2 mmol/L, respectively. No significant differences were found in the areas under the curve for each outcome. Of the two markers, a lactate of >5.1 mmol/L was associated with mortality (adjusted odds ratio, 6.43; 95% confidence interval, 2.61-15.84). A lactate of >3.2 mmol/L (2.82; 1.65-4.83) and a BD of >4.9 mmol/L (2.32; 1.32-4.10) were associated with transfusion, while only a BD of >5.2 mmol/L (2.17; 1.26-3.75) was done with surgical interventions.

CONCLUSIONS

In pediatric trauma, lactate is more strongly associated with mortality. In contrast, BD may have a marginally stronger association with the need for hemorrhage-related procedures.