Capillary lactate concentration on admission of normotensive trauma patients: a prospective study

Pierre Bouzat, Clotilde Schilte, Marc Vinclair, Pauline Manhes, Julien Brun, Jean-Luc Bosson, Jean-François Payen, Pierre Bouzat, Clotilde Schilte, Marc Vinclair, Pauline Manhes, Julien Brun, Jean-Luc Bosson, Jean-François Payen

Abstract

Background: Elevated serum blood lactate is an indicator of on-going bleeding in severe trauma patients. Point-of-care (POC) capillary lactate measurement devices may be useful to rapidly assess lactate concentration at the bedside. The aim of this study was to test the diagnostic performance of capillary lactate to predict significant transfusion in normotensive trauma patients.

Methods: We conducted a prospective observational study in one level-I trauma centre. From August 2011 to February 2013, 120 consecutive adult patients with systolic blood pressure (SBP) higher than 90 mmHg were included. Capillary lactate was measured on admission in the trauma bay. The primary outcome was defined as a significant transfusion within the first 48 h. Diagnostic performance was determined using receiver operating characteristic (ROC) curve analysis. We also tested the agreement between capillary lactate and blood lactate concentrations using Bland and Altman analysis.

Results: Of the 120 normotensive trauma patients, 30 (25 %) required at least one unit of packed red blood cells (RBC) and 12 (10 %) patients received at least four RBC within the first 48 h. All patients with significant RBC transfusion had capillary lactate higher than 3.5 mmol/l. The area under the ROC curve of capillary lactate on admission to predict transfusion of at least 4 RBC units was 0.68 [95 % CI 0.58 - 0.78]. The average bias between capillary and blood lactate measurements was 2.4 mmol/l with a standard deviation of 3.0 mmol/l (n = 60 patients).

Conclusions: Although a significant association was found between POC lactate concentration and transfusion requirements, the diagnostic performance of capillary lactate measurements was poor. Due to large disagreement between capillary lactate and blood lactate, capillary lactate cannot be considered in the clinical setting.

Trial registration: ClinicalTrials.gov, No. NCT01793428 .

Keywords: Lactate; Point-of-care; Severe trauma; Transfusion.

Figures

Fig. 1
Fig. 1
Receiver operating characteristic curves of capillary lactate on admission and prehospital shock index to predict a significant transfusion in the cohort (n = 120 patients)
Fig. 2
Fig. 2
Agreement between the capillary lactate measurement device and serum blood lactate concentration via the Bland & Altman representation (n = 60 patients). Central dash-line represents the linear bias between the two methods. Upper and lower black lines represent the 95 % prediction limits for the blood lactate given the value by the capillary method
Fig. 3
Fig. 3
Allocation of packed red blood cells (RBC) units across individual patients according to the category of capillary lactate concentration on admission (p < 0.01

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Source: PubMed

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