PDF(Pubmed)
Abstract：
BACKGROUND: Elevated lactate levels are associated with increased mortality in both trauma and non-trauma patients. The relation between base deficit (BD) and mortality is less clear. Traumatologists debate the utility of elevated lactate (EL) versus BD in predicting mortality. We hypothesized that EL (2mmol/L to 5mmol/L) and BD (≤-2mmol/L) in combination could predict mortality in blunt trauma patients. Methods: This is a retrospective analysis of the trauma registry from 2012 to 2021 at a level 1 trauma center. Blunt trauma patients with admission lactate and BD values were included in the analysis. Exclusion criteria were age <18, penetrating trauma, unknown mortality, and unknown lactate or BD. Logistics regression of the total 5153 charts showed 93% of the patients presented with lactate levels <5mmol/L, therefore patients with lactate >5mmol/L were excluded as outliers. The primary outcome was mortality.
RESULTS: A total of 4794 patients (151 non-survivors) were included in the analysis. Non-survivors had higher rates of EL + BD (35.8% vs. 14.4%, p <0.001). When comparing survivors and non-survivors, EL + BD (OR 5.69), age >65 (5.17), injury severity score (ISS) >25 (8.87), Glasgow coma scale <8 (8.51), systolic blood pressure (SBP) <90 (4.2), and ICU admission (2.61) were significant predictors of mortality. Other than GCS <8 and ISS >25, EL + BD had the highest odds of predicting mortality.
CONCLUSIONS: Elevated lactate + BD on admission in combination represents a 5.6-fold increase in mortality in blunt trauma patients and can be used to predict a patient\'s outcome on admission. This combination variable provides an additional early data point to identify patients at elevated risk of mortality at the moment of admission.
RESULTS: A total of 4794 patients (151 non-survivors) were included in the analysis. Non-survivors had higher rates of EL + BD (35.8% vs. 14.4%, p <0.001). When comparing survivors and non-survivors, EL + BD (OR 5.69), age >65 (5.17), injury severity score (ISS) >25 (8.87), Glasgow coma scale <8 (8.51), systolic blood pressure (SBP) <90 (4.2), and ICU admission (2.61) were significant predictors of mortality. Other than GCS <8 and ISS >25, EL + BD had the highest odds of predicting mortality.
CONCLUSIONS: Elevated lactate + BD on admission in combination represents a 5.6-fold increase in mortality in blunt trauma patients and can be used to predict a patient\'s outcome on admission. This combination variable provides an additional early data point to identify patients at elevated risk of mortality at the moment of admission.
摘要：
背景：乳酸水平升高与创伤和非创伤患者死亡率增加相关。基数赤字（BD）与死亡率之间的关系尚不清楚。创伤学家争论乳酸（EL）与BD升高在预测死亡率方面的效用。我们假设EL（2mmol/L至5mmol/L）和BD（≤-2mmol/L）的组合可以预测钝性创伤患者的死亡率。方法：回顾性分析2012年至2021年在一级创伤中心进行的创伤登记。纳入分析的钝性创伤患者入院时乳酸和BD值。排除标准为年龄<18岁，穿透性创伤，未知死亡率,和未知的乳酸或BD。总共5153个图表的后勤回归显示，93%的患者表现为乳酸水平<5mmol/L，因此，乳酸>5mmol/L的患者被排除为异常值。主要结果是死亡率。
结果：共有4794名患者（151名非幸存者）纳入分析。非幸存者的EL+BD发生率更高(35.8%vs.14.4%,p<0.001)。当比较幸存者和非幸存者时，EL+BD（或5.69），年龄>65（5.17），损伤严重程度评分（ISS）>25（8.87），格拉斯哥昏迷评分<8（8.51），收缩压（SBP）<90（4.2），入住ICU(2.61)是死亡率的显著预测因子.除GCS<8和ISS>25外，EL+BD预测死亡率的几率最高。
结论：合并入院时乳酸+BD升高代表钝性创伤患者死亡率增加5.6倍，可用于预测患者入院时的预后。该组合变量提供了额外的早期数据点，以识别入院时死亡风险升高的患者。
结果：共有4794名患者（151名非幸存者）纳入分析。非幸存者的EL+BD发生率更高(35.8%vs.14.4%,p<0.001)。当比较幸存者和非幸存者时，EL+BD（或5.69），年龄>65（5.17），损伤严重程度评分（ISS）>25（8.87），格拉斯哥昏迷评分<8（8.51），收缩压（SBP）<90（4.2），入住ICU(2.61)是死亡率的显著预测因子.除GCS<8和ISS>25外，EL+BD预测死亡率的几率最高。
结论：合并入院时乳酸+BD升高代表钝性创伤患者死亡率增加5.6倍，可用于预测患者入院时的预后。该组合变量提供了额外的早期数据点，以识别入院时死亡风险升高的患者。
