Huh Yo, Ko Yura, Hwang Kyungjin, Jung Kyoungwon, Cha Yoon-Ho, Choi Yoo Jin, Lee Jisook, Kim Jung Heon
Division of Trauma Surgery, Department of Surgery, Ajou University School of Medicine, Suwon, Korea.
Department of Emergency Medicine, Ajou University School of Medicine, Suwon, Korea.
Shock. 2021 Apr 1;55(4):495-500. doi: 10.1097/SHK.0000000000001652.
To compare admission lactate and base deficit (BD), which physiologically reflect early hemorrhagic shock, as outcome predictors of pediatric trauma.
We reviewed the data of children with trauma who visited a Korean academic hospital from 2010 through 2018. Admission lactate and BD were compared between children with and without primary outcomes. The outcomes included in-hospital mortality, early (≤24 h) transfusion, and early surgical interventions for the torso or major vessels. Subsequently, performances of lactate and BD in predicting the outcomes were compared using receiver operating characteristic curves. Logistic regressions were conducted to identify the independent associations of the two markers with each outcome.
Of the 545 enrolled children, the mortality, transfusion, and surgical interventions occurred in 7.0%, 43.5%, and 14.9%, respectively. Cutoffs of lactate and BD for each outcome were as follows: mortality, 5.1 and 6.7 mmol/L; transfusion, 3.2 and 4.9 mmol/L; and surgical interventions, 2.9 and 5.2 mmol/L, respectively. No significant differences were found in the areas under the curve for each outcome. Of the two markers, a lactate of >5.1 mmol/L was associated with mortality (adjusted odds ratio, 6.43; 95% confidence interval, 2.61-15.84). A lactate of >3.2 mmol/L (2.82; 1.65-4.83) and a BD of >4.9 mmol/L (2.32; 1.32-4.10) were associated with transfusion, while only a BD of >5.2 mmol/L (2.17; 1.26-3.75) was done with surgical interventions.
In pediatric trauma, lactate is more strongly associated with mortality. In contrast, BD may have a marginally stronger association with the need for hemorrhage-related procedures.
比较入院时的乳酸水平和碱缺失（BD），这两者在生理上反映早期失血性休克，作为儿童创伤的预后预测指标。
我们回顾了2010年至2018年在一家韩国学术医院就诊的创伤儿童的数据。比较有和没有主要结局的儿童的入院乳酸水平和BD。结局包括院内死亡率、早期（≤24小时）输血以及针对躯干或大血管的早期手术干预。随后，使用受试者工作特征曲线比较乳酸和BD在预测结局方面的表现。进行逻辑回归以确定这两个指标与每个结局的独立关联。
在545名登记儿童中，死亡率、输血率和手术干预率分别为7.0%、43.5%和14.9%。每种结局的乳酸和BD临界值如下：死亡率，5.1和6.7毫摩尔/升；输血，3.2和4.9毫摩尔/升；手术干预，分别为2.9和5.2毫摩尔/升。每种结局的曲线下面积未发现显著差异。在这两个指标中，乳酸水平>5.1毫摩尔/升与死亡率相关（调整后的优势比，6.43；95%置信区间，2.61 - 15.84）。乳酸水平>3.2毫摩尔/升（2.82；1.65 - 4.83）和BD>4.9毫摩尔/升（2.32；1.32 - 4.10）与输血相关，而只有BD>5.2毫摩尔/升（2.17；1.26 - 3.75）与手术干预相关。
在儿童创伤中，乳酸与死亡率的关联更强。相比之下，BD可能与出血相关手术需求的关联略强。
