Combination of Lactate and Base Deficit Levels at Admission to Predict Mortality in Blunt Trauma Patients

Candace L Ward; Samantha N Olafson; Ryan B Cohen; Mark J Kaplan; Alexi Bloom; Afshin Parsikia; Benjamin J Moran; Pak S Leung

doi:10.7759/cureus.40097

Combination of Lactate and Base Deficit Levels at Admission to Predict Mortality in Blunt Trauma Patients

Cureus. 2023 Jun 7;15(6):e40097. doi: 10.7759/cureus.40097. eCollection 2023 Jun.

Authors

Candace L Ward¹, Samantha N Olafson², Ryan B Cohen², Mark J Kaplan³, Alexi Bloom⁴, Afshin Parsikia⁵, Benjamin J Moran⁴, Pak S Leung⁴

Affiliations

¹ Surgery, Einstein Medical Center Philadelphia, Philadelphia, USA.
² General Surgery, Einstein Medical Center Philadelphia, Philadelphia, USA.
³ Trauma and Acute Care Surgery, Einstein Healthcare Network, Philadelphia, USA.
⁴ Trauma and Acute Care Surgery, Einstein Medical Center Philadelphia, Philadelphia, USA.
⁵ General Surgery, Einstein Healthcare Network, Philadelphia, USA.

Abstract

Introduction: Elevated lactate levels are associated with increased mortality in both trauma and non-trauma patients. The relation between base deficit (BD) and mortality is less clear. Traumatologists debate the utility of elevated lactate (EL) versus BD in predicting mortality. We hypothesized that EL (2mmol/L to 5mmol/L) and BD (≤-2mmol/L) in combination could predict mortality in blunt trauma patients. Methods: This is a retrospective analysis of the trauma registry from 2012 to 2021 at a level 1 trauma center. Blunt trauma patients with admission lactate and BD values were included in the analysis. Exclusion criteria were age <18, penetrating trauma, unknown mortality, and unknown lactate or BD. Logistics regression of the total 5153 charts showed 93% of the patients presented with lactate levels <5mmol/L, therefore patients with lactate >5mmol/L were excluded as outliers. The primary outcome was mortality.

Results: A total of 4794 patients (151 non-survivors) were included in the analysis. Non-survivors had higher rates of EL + BD (35.8% vs. 14.4%, p <0.001). When comparing survivors and non-survivors, EL + BD (OR 5.69), age >65 (5.17), injury severity score (ISS) >25 (8.87), Glasgow coma scale <8 (8.51), systolic blood pressure (SBP) <90 (4.2), and ICU admission (2.61) were significant predictors of mortality. Other than GCS <8 and ISS >25, EL + BD had the highest odds of predicting mortality.

Conclusion: Elevated lactate + BD on admission in combination represents a 5.6-fold increase in mortality in blunt trauma patients and can be used to predict a patient's outcome on admission. This combination variable provides an additional early data point to identify patients at elevated risk of mortality at the moment of admission.

Keywords: base deficit; blood lactate levels; blunt force trauma; predictive model; trauma resuscitation.