Acute Crit Care.  2019 Nov;34(4):255-262. 10.4266/acc.2019.00640.

The association between the initial lactate level and need for massive transfusion in severe trauma patients with and without traumatic brain injury

• Park YH
• Ryu DH
• Lee BK
• Lee DH

• KMID: 2467304
• DOI: http://doi.org/10.4266/acc.2019.00640

Abstract

BACKGROUND
Exsanguination is a major cause of death in severe trauma patients. The purpose of this study was to analyze the prognostic impact of the initial lactate level for massive transfusion (MT) in severe trauma. We divided patients according to subgroups of traumatic brain injury (TBI) and non-TBI.
METHODS
This single-institution retrospective study was conducted on patients who were admitted to hospital for severe trauma between January 2016 and December 2017. TBI was defined by a head Abbreviated Injury Scale ≥3. Receiver operating characteristic analysis was used to analyze the prognostic impact of the lactate level. Multivariate analyses were performed to evaluate the relationship between the MT and lactate level. The primary outcome was MT.
RESULTS
Of the 553 patients, MT was performed in 62 patients (11.2%). The area under the curve (AUC) for the lactate level for predicting MT was 0.779 (95% confidence interval [CI], 0.742 to 0.813). The AUCs for lactate level in the TBI and non-TBI patients were 0.690 (95% CI, 0.627 to 0.747) and 0.842 (95% CI, 0.796 to 0.881), respectively. In multivariate analyses, the lactate level was independently associated with the MT (odds ratio [OR], 1.179; 95% CI, 1.070 to 1.299). The lactate level was independently associated with MT in non-TBI patients (OR, 1.469; 95% CI, 1.262 to 1.710), but not in TBI patients.
CONCLUSIONS
The initial lactate level may be a possible prognostic factor for MT in severe trauma. In TBI patients, however, the initial lactate level was not suitable for predicting MT.

Keyword

blood transfusion; lactate; trauma; traumatic brain injury

MeSH Terms

Abbreviated Injury Scale
Area Under Curve
Blood Transfusion
Brain Injuries*
Cause of Death
Exsanguination
Head
Humans
Lactic Acid*
Multivariate Analysis
Retrospective Studies
ROC Curve
Lactic Acid

Figure

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  Figure 1. Schematic diagram showing the number of patients with severe trauma included in this study. ISS: Injury Severity Score; ED: emergency department.

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  Figure 2. The areas under the curve (AUCs) for predicting massive transfusion between hemoglobin, Injury Severity Score (ISS), Revised Trauma Score (RTS), systolic blood pressure (SBP), and lactate levels. (A) AUC in all patients. The AUC of the lactate level was significantly different from that of ISS (P=0.006), but not significantly different from that of the RTS (P=0.054), SBP (P=0.726), and hemoglobin level (P=0.154). (B) AUC in traumatic brain injury (TBI) patients. (C) AUC in non-TBI patients. In non-TBI patients, the AUC of the lactate level was significantly different from that of ISS (P=0.003), RTS (P=0.008), SBP (P=0.016) and, hemoglobin level (P=0.021).

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