Lactate as an early predictor for early massive transfusion in trauma patients: A retrospective study

• Published in: Hong Kong journal of emergency medicine 2016-09, Vol.23 (5), p.266-272
• Main Authors: Kyoung, Kh, Kim, Yh, Jung, Yj, Hong, Sk
• Format: Article
• Language: English
• Subjects: Acidosis; Blood; Brain; Hemorrhage; Lactates; Patients; Post-traumatic stress disorder; Transfusion; Trauma; Treatment; Wounds and injuries
• ISSN: 1024-9079; 2309-5407
• DOI: 10.1177/102490791602300502

Objective: Transfusion is a key treatment for patients with hemorrhage. Early massive transfusion (EMT) is defined as transfusion of 10 or more units of red blood cells (RBC) within the first 6 hours. We attempted to determine whether metabolic markers can be used as predictors for EMT. Method: We retrospectively reviewed outcomes in 71 patients who visited the emergency department within 12 hours after trauma and received at least 1 unit of RBC within 24 hours between January 2008 and June 2010. Results: Of the 71 patients, 54 were male and 17 were female; their mean age was 50.3+-17.7 years. Of these, 15 required EMT and 56 did not; these patients received 17.7+-13.1 and 2.8+-2.3 units of RBCs, respectively. There were significant differences between EMT and non-EMT groups in injury severity score (ISS; p=0.001), systolic blood pressure (SBP; p=0.010), base deficit (p=0.003), and lactate concentration (p=0.001). Logistic regression analysis showed that SBP =25 (OR 23.39, 95% CI 1.87-293.23, p=0.015), and lactate >=3.5 mmol/L (OR 6.99, 95% CI 1.10- 44.33, p=0.039) were significant predictors of EMT. The area under the curve for >=3.5 mmol/L lactate was 0.79 (p=0.001), with a sensitivity of 76.7% and a specificity of 67.8%. The 30-day mortality rate was significantly higher in patients with lactate >=3.5 mmol/L than in those with lactate