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Lactate predicts massive transfusion in hemodynamically normal patients.

Magdalene Brooke1, Louise Yeung1, Emily Miraflor1

  • 1Department of Surgery, University of California San Francisco East Bay, Oakland, California.

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|July 26, 2016
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Summary

Elevated admission lactate levels in trauma patients who appear hemodynamically stable can predict the need for massive transfusion. A lactate threshold of 4 mmol/L identifies patients at higher risk for poor outcomes.

Keywords:
Blood productHemodynamically normalLactateMassive transfusionStableTrauma

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Area of Science:

  • Trauma Surgery
  • Emergency Medicine
  • Critical Care

Background:

  • Trauma patients with occult injuries may present as hemodynamically normal.
  • Early identification of deteriorating patients is crucial, particularly those needing massive transfusion (MT).
  • Admission lactate levels may serve as an early indicator for MT in stable-appearing trauma patients.

Purpose of the Study:

  • To investigate the hypothesis that elevated admission lactate predicts the need for massive transfusion in hemodynamically normal trauma patients.
  • To determine the predictive value of admission lactate for massive transfusion and associated outcomes.

Main Methods:

  • Retrospective review of trauma patients over a 5-year period at an urban university-based center.
  • Inclusion of hemodynamically normal patients with recorded admission lactate levels.
  • Receiver-operating curve analysis to establish lactate threshold; chi-square, t-tests, and regression analyses for variable assessment.

Main Results:

  • Patients receiving massive transfusion (MT) had significantly higher admission lactate levels (5.6 vs 2.6 mmol/L).
  • A lactate threshold of 4 mmol/L was identified (AUC 0.71).
  • Lactate >4 mmol/L correlated with increased mortality, longer hospital and ICU stays, and greater need for MT and blood products.

Conclusions:

  • Admission lactate >4 mmol/L is a strong predictor of massive transfusion requirement in hemodynamically normal trauma patients.
  • Elevated lactate levels in this cohort are associated with adverse outcomes.
  • Lactate measurement offers a valuable tool for early risk stratification in trauma care.