The relationship of serum lactate and base deficit in burn patients to mortality

Serum lactate and base deficit in trauma patients have been shown to correlate with mortality. This study examines the relationship of these parameters to mortality among burn patients. We evaluated patients with >or=20% TBSA burn injury who had a serum lactate or base deficit recorded during the initial 48 hours of admission over a 5-year period. The primary study outcome was mortality. The mean (+/-SD) age of study patients (N = 128) was 35.2 +/- 21.1 years, the mean burn size was 41.7 +/- 17.9% TBSA, and the mortality rate was 17.1%. Mean serum lactate values of patients who died were significantly higher than those of survivors at admission and at 12, 18, and 24 hours after admission. The highest serum lactate value in the first 48 hours after admission was higher for nonsurvivors than survivors. Mean base deficit at admission and 6 hours after admission was significantly lower in patients who died than in survivors; in addition, the worst base deficit during the first 48 hours of care was significantly lower in patients who died than in those who survived. Early serum lactate and base deficit values are often worse for burn patients who die than for survivors. Elevation of serum lactate values during the first 48 hours after a burn is an independent risk factor for death, but no threshold value for serum lactate is demonstrable. Resuscitation should not be withheld from burn patients on the basis of any lactate or base deficit value.