Lactate Clearance
As a predictor of mortality in trauma patients
Reno Rudiman
Why do we need predictor?
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Why do we need predictor?
• Important in clinical uncertainty
• Mis-inference may result in an
increased risk of an adverse event
• Avoiding unnecessary cost of care
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Mortality of trauma
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Mortality of trauma
• 10% of all deaths are caused by trauma (Maegel
2010)
• In Indonesia 2011, there were 108.696 traffic
accidents, of which 31.195 dead (BPS, 2011)
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Lactate
• End product of anaerobic metabolism
• Marker for cellular hypoxia in shock
• Early identification of severe injury
Lactate clearance
• Rapid clearance of lactate is
associated with improved outcome in
septic shock & critically ill
• Is it a better indicator for ongoing
tissue hypoperfusion?
• Better guide for resuscitation?
Lactate clearance
Lactate clearance = ([Lactateinitial –
Lactatedelayed]/ Lactateinitial) × 100 ×
Delay−1 (expressed as %/h)
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Admission Lactate
6
4.5
3
1.5
0
died
survived
Pal JD, et al. J Trauma 2006; 60: 583-589
Initial lactate: survivors vs nonsurvivors
Pal JD, et al. J Trauma 2006; 60: 583-589
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Admission Lactate
Although mean admission lactate was significantly
lower in survivors than nonsurvivors, the overlap
between the groups was so great that little ability to
discriminate survivors from non-survivors is
apparent
Pal JD, et al. J Trauma 2006; 60: 583-589
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SBP on mortality
Odom et al. J Trauma Acute Care Surg 2013; 74(4): 999-1004
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Survival probability
Odom et al. J Trauma Acute Care Surg 2013; 74(4): 999-1004
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Relationship of lactate and ISS values
in 5,995 trauma patients
Pal JD, et al. J Trauma 2006; 60: 583-589
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Lactate on mortality
Odom et al. J Trauma Acute Care Surg 2013; 74(4): 999-1004
Lactate on mortality
Regnier, et al. Anesthesiology 2012; 71(6): 1276-1288
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Lactate on mortality
Regnier, et al. Anesthesiology 2012; 71(6): 1276-1288
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Successful vs failed Non Operative
management in blunt abdominal trauma
successful
failed
2.2
1.65
1.1
0.55
0
initial p=0,356
post p<0,01
Haryatama, Rudiman, Sulthana. In publication, 2012.
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Successful vs failed Non Operative
management in blunt abdominal trauma
Successful
Failed
lactate pre vs post
lactate pre vs BE pre
latate post vs BE post
BE pre vs post
lactate diff vs BE diff
-0.7
-0.35
0
0.35
Haryatama, Rudiman, Sulthana. In publication, 2012.
0.7
1.05
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Mortality according to initial blood lactate
level and/or lactate clearance (n = 453)
Regnier, et al. Anesthesiology 2012; 71(6): 1276-1288
20
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Conclusion
• Lactate clearance provides additional
predictive information to initial blood
lactate levels and scores
• Lactate clearance is a useful
prognostic variable in trauma
patients.
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