Critical Care Medicine  |   March 2017
Comparison of the Prognostic Significance of Initial Blood Lactate and Base Deficit in Trauma Patients
Author Notes
  • From the Sorbonne Universités, UPMC Univ Paris 06, Pierre et Marie-Curie-Paris 6, UMRS 1166 (B.R.), and UMRS 1158, Neurophysiologie Respiratoire Experimentale et Clinique (M.R.), Paris, France; Departments of Anesthesiology and Critical Care (M.R., R.B.) and Emergency Medicine and Surgery (B.R.), Centre Hospitalo-Universitaire (CHU) Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris (APHP), Paris, France; Departments of Anesthesia and Clinical Epidemiology and Biostatistics, Michael DeGroote School of Medicine, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada (Y.L.M.); Department of Anesthesiology and Critical Care, CHU Beaujon, APHP, Clichy, France (T.G.); and Department of Anesthesiology and Critical Care, CHU Bicêtre, APHP, Le Kremlin-Bicêtre, France (S.H., A.H).
  • Le Kremlin-Bicêtre, France
  • Paris, France
  • Paris, France
  • Clichy, France
  • Le Kremlin-Bicêtre, France
  • *Members of the TRAUMABASE® Group are listed in the appendix.
    Members of the TRAUMABASE® Group are listed in the appendix.×
  • Submitted for publication April 20, 2016. Accepted for publication December 1, 2016.
    Submitted for publication April 20, 2016. Accepted for publication December 1, 2016.×
  • Address correspondence to Dr. Raux: Département d’Anesthésie-Réanimation, CHU Pitié-Salpêtrière, 47 Boulevard de l’Hôpital, 75651 Paris Cedex 13, France. mathieu.raux@aphp.fr. Information on purchasing reprints may be found at www.anesthesiology.org or on the masthead page at the beginning of this issue. Anesthesiology’s articles are made freely accessible to all readers, for personal use only, 6 months from the cover date of the issue.
Article Information
Critical Care Medicine / Clinical Science / Critical Care / Renal and Urinary Systems / Electrolyte Balance / Trauma / Burn Care
Critical Care Medicine   |   March 2017
Comparison of the Prognostic Significance of Initial Blood Lactate and Base Deficit in Trauma Patients
Anesthesiology 3 2017, Vol.126, 522-533. doi:10.1097/ALN.0000000000001490
Anesthesiology 3 2017, Vol.126, 522-533. doi:10.1097/ALN.0000000000001490
Abstract

Background: Initial blood lactate and base deficit have been shown to be prognostic biomarkers in trauma, but their respective performances have not been compared.

Methods: Blood lactate levels and base deficit were measured at admission in trauma patients in three level 1 trauma centers. This was a retrospective analysis of prospectively acquired data. The association of initial blood lactate and base deficit with mortality was tested using receiver operating characteristics curve, logistic regression using triage scores (Revised Trauma Score and Mechanism Glasgow scale and Arterial Pressure score), and Trauma Related Injury Severity Score as a reference standard. The authors also used a reclassification method.

Results: The authors evaluated 1,075 trauma patients (mean age, 39 ± 18 yr, with 90% blunt and 10% penetrating injuries and a mortality of 13%). At admission, blood lactate was elevated in 425 (39%) patients and base deficit was elevated in 725 (67%) patients. Blood lactate was correlated with base deficit (R2 = 0.54; P < 0.001). Using logistic regression, blood lactate was a better predictor of death than base deficit when considering its additional predictive value to triage scores and Trauma Related Injury Severity Score. This result was confirmed using a reclassification method but only in the subgroup of normotensive patients (n = 745).

Conclusions: Initial blood lactate should be preferred to base deficit as a biologic variable in scoring systems built to assess the initial severity of trauma patients.