Combining the Lactate Level and Shock Index for Predicting Postpartum Hemorrhage Outcomes: An 11-Year Retrospective...

Area of Science:

• Obstetrics and Gynecology
• Emergency Medicine
• Clinical Biochemistry

Background:

• Accurate assessment of postpartum hemorrhage (PPH) severity is challenging using estimated blood loss alone.
• There is a need for reliable physiological or biochemical markers for early PPH risk stratification.
• Initial clinical indicators require evaluation for their prognostic value in PPH.

Purpose of the Study:

• To assess the association of initial lactate levels and shock index with major PPH outcomes.
• To compare the discriminative performance of lactate and shock index in predicting PPH complications.
• To evaluate the combined predictive power of lactate and shock index for PPH severity.

Main Methods:

• Retrospective analysis of 424 PPH cases from 2013-2023 at a South Korean tertiary hospital.
• Outcomes assessed: massive transfusion, hysterectomy, uterine artery embolization, and ICU admission.
• Logistic regression and ROC analyses were used to determine prognostic factors and compare performance.

Main Results:

• Initial lactate levels were independently associated with massive transfusion (aOR 1.35) and ICU admission (aOR 1.36).
• Lactate demonstrated high discriminative performance for massive transfusion (AUC 0.86) and hysterectomy (AUC 0.84).
• The combination of lactate and shock index yielded the highest performance for massive transfusion (AUC 0.88).

Conclusions:

• Initial lactate levels are valuable predictors of severe PPH outcomes, particularly massive transfusion.
• Combining lactate with the shock index improves the prediction of critical PPH complications.
• Lactate-based assessment can aid in early risk stratification and clinical decision-making for PPH management.