Elevated lactate level predicts intensive care unit admissions, endoscopies and transfusions in patients with acute gastrointestinal bleeding

Manish P Shrestha, Mark Borgstrom, Eugene Abraham Trowers, Manish P Shrestha, Mark Borgstrom, Eugene Abraham Trowers

Abstract

Background and aims: Initial clinical management decision in patients with acute gastrointestinal bleeding (GIB) is often based on identifying high- and low-risk patients. Little is known about the role of lactate measurement in the triage of patients with acute GIB. We intended to assess if lactate on presentation is predictive of need for intervention in patients with acute GIB.

Patients and methods: We performed a single-center, retrospective, cross-sectional study including patients ≥18 years old presenting to emergency with acute GIB between January 2014 and December 2014. Intensive care unit (ICU) admission, inpatient endoscopy (upper endoscopy and/or colonoscopy), and packed red blood cell (PRBC) transfusion were assessed as outcomes. Analyses included univariate and multivariate logistic regression analyses.

Results: Of 1,237 patients with acute GIB, 468 (37.8%) had venous lactate on presentation. Of these patients, 165 (35.2%) had an elevated lactate level (>2.0 mmol/L). Patients with an elevated lactate level were more likely to be admitted to ICU than patients with a normal lactate level (adjusted odds ratio [AOR] 2.96, 95% confidence interval [CI] 1.74-5.01; p<0.001). Patients with an elevated lactate level were more likely to receive PRBC transfusion (AOR 3.65, 95% CI 1.76-7.55; p<0.001) and endoscopy (AOR 1.64, 95% CI 1.02-2.65; p=0.04) than patients with a normal lactate level.

Conclusion: Elevated lactate level predicts the need for ICU admissions, transfusions, and endoscopies in patients with acute GIB. Lactate measurement may be a useful adjunctive test in the triage of patients with acute GIB.

Keywords: ICU admissions; acute gastrointestinal bleeding; endoscopy; venous lactate.

Conflict of interest statement

Disclosure The authors report no conflicts of interest in this work.

Figures

Figure 1
Figure 1
Area under the ROC curve of predictive model for ICU admission. Abbreviations: ROC, receiver operating characteristic; ICU, intensive care unit.
Figure 2
Figure 2
Area under the ROC curve of predictive model for inpatient endoscopy. Abbreviation: ROC, receiver operating characteristic.

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