Park Young Hoon, Ryu Dong Hyun, Lee Byung Kook, Lee Dong Hun
Department of Emergency Medicine, Chonnam National University Hospital, Gwangju, Korea.
Acute Crit Care. 2019 Nov;34(4):255-262. doi: 10.4266/acc.2019.00640. Epub 2019 Nov 29.
Exsanguination is a major cause of death in severe trauma patients. The purpose of this study was to analyze the prognostic impact of the initial lactate level for massive transfusion (MT) in severe trauma. We divided patients according to subgroups of traumatic brain injury (TBI) and non-TBI.
This single-institution retrospective study was conducted on patients who were admitted to hospital for severe trauma between January 2016 and December 2017. TBI was defined by a head Abbreviated Injury Scale ≥3. Receiver operating characteristic analysis was used to analyze the prognostic impact of the lactate level. Multivariate analyses were performed to evaluate the relationship between the MT and lactate level. The primary outcome was MT.
Of the 553 patients, MT was performed in 62 patients (11.2%). The area under the curve (AUC) for the lactate level for predicting MT was 0.779 (95% confidence interval [CI], 0.742 to 0.813). The AUCs for lactate level in the TBI and non-TBI patients were 0.690 (95% CI, 0.627 to 0.747) and 0.842 (95% CI, 0.796 to 0.881), respectively. In multivariate analyses, the lactate level was independently associated with the MT (odds ratio [OR], 1.179; 95% CI, 1.070 to 1.299). The lactate level was independently associated with MT in non-TBI patients (OR, 1.469; 95% CI, 1.262 to 1.710), but not in TBI patients.
The initial lactate level may be a possible prognostic factor for MT in severe trauma. In TBI patients, however, the initial lactate level was not suitable for predicting MT.
失血性休克是严重创伤患者死亡的主要原因。本研究旨在分析初始乳酸水平对严重创伤患者大量输血（MT）预后的影响。我们根据创伤性脑损伤（TBI）和非TBI亚组对患者进行了划分。
本单机构回顾性研究针对2016年1月至2017年12月因严重创伤入院的患者开展。TBI由头部简明损伤量表≥3定义。采用受试者工作特征分析来分析乳酸水平的预后影响。进行多因素分析以评估MT与乳酸水平之间的关系。主要结局为MT。
553例患者中，62例（11.2%）接受了MT。预测MT的乳酸水平曲线下面积（AUC）为0.779（95%置信区间[CI]，0.742至0.813）。TBI患者和非TBI患者乳酸水平的AUC分别为0.690（95%CI，0.627至0.747）和0.842（95%CI，0.796至0.881）。在多因素分析中，乳酸水平与MT独立相关（比值比[OR]，1.179；95%CI，1.070至1.299）。乳酸水平在非TBI患者中与MT独立相关（OR = 1.469；95%CI，1.262至1.710），但在TBI患者中并非如此。
初始乳酸水平可能是严重创伤患者MT的一个预后因素。然而，在TBI患者中，初始乳酸水平不适用于预测MT。
