J Korean Med Sci.  2017 Nov;32(11):1820-1827. 10.3346/jkms.2017.32.11.1820.

Lactate Parameters Predict Clinical Outcomes in Patients with Nonvariceal Upper Gastrointestinal Bleeding

• Lee SH
• Min YW
• Bae J
• Lee H
• Min BH
• Lee JH
• Rhee PL
• Kim JJ

• KMID: 2390309
• DOI: http://doi.org/10.3346/jkms.2017.32.11.1820

Abstract

The predictive role of lactate in patients with nonvariceal upper gastrointestinal bleeding (NVUGIB) has been suggested. This study evaluated several lactate parameters in terms of predicting outcomes of bleeding patients and sought to establish a new scoring model by combining lactate parameters and the AIMS65 score. A total of 114 patients with NVUGIB who underwent serum lactate level testing at least twice and endoscopic hemostasis within 24 hours after admission were retrospectively analyzed. The associations between five lactate parameters and clinical outcomes were evaluated and the predictive power of lactate parameter combined AIMS65s (L-AIMS65s) and AIMS56 scoring was compared. The most common cause of bleeding was gastric ulcer (48.2%). Lactate clearance rate (LCR) was associated with 30-day rebleeding (odds ratio [OR], 0.931; 95% confidence interval [CI], 0.872-0.994; P = 0.033). Initial lactate (OR, 1.313; 95% CI, 1.050-1.643; P = 0.017), maximal lactate (OR, 1.277; 95% CI, 1.037-1.573; P = 0.021), and average lactate (OR, 1.535; 95% CI, 1.137-2.072; P = 0.005) levels were associated with 30-day mortality. Initial lactate (OR, 1.213; 95% CI, 1.027-1.432; P = 0.023), maximal lactate (OR, 1.271; 95% CI, 1.074-1.504; P = 0.005), and average lactate (OR, 1.501; 95% CI, 1.150-1.959; P = 0.003) levels were associated with admission over 7 days. Although L-AIMS65s showed the highest area under the curve for prediction of each outcome, differences between L-AIMS65s and AIMS65 did not reach statistical significance. In conclusion, lactate parameters have a prognostic role in patients with NVUGIB. However, they do not increase the predictive power of AIMS65 when combined.

Keyword

AIMS65; Lactate; Mortality; Nonvariceal Upper Gastrointestinal Bleeding; Rebleeding

MeSH Terms

Hemorrhage*
Hemostasis, Endoscopic
Humans
Lactic Acid*
Mortality
Retrospective Studies
Stomach Ulcer
Lactic Acid

Figure

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  Fig. 1 Flow of subject inclusion. NVUGIB = nonvariceal upper gastrointestinal bleeding.

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  Fig. 2 ROC curves of L-AIMS65s and AIMS65 score for clinical outcomes of patients with NVUGIB. (A) Thirty-day rebleeding. (B) Thirty-day mortality. (C) Hypotension. (D) Active bleeding. (E) Admission to ICU. (F) Admission over 7 days. ROC = receiver operating characteristic, L-AIMS65s = lactate parameters combined AIMS65 scores, NVUGIB = nonvariceal upper gastrointestinal bleeding, ICU = intensive care unit.

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