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Irish Journal of Medical Science (1971 -)

Erschienen in:

13.10.2022 | Original Article

Early lactate clearance for predicting outcomes in patients with gastrointestinal bleeding

verfasst von: Keon Kim, Dong Hoon Lee, Duk Hee Lee, Yoon Hee Choi, Sung Jin Bae

Erschienen in: Irish Journal of Medical Science (1971 -) | Ausgabe 4/2023

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Abstract

Background

Acute gastrointestinal bleeding (GI bleeding) can range from mild symptoms to life-threatening conditions that require emergency intervention. Therefore, it is important to first identify the high-risk and low-risk patients in the emergency department (ED).

Aims

This study aimed to investigate the usefulness of a three-hourly interval for determining the lactate clearance, which is shorter than the time interval in previous studies, in order to predict the prognosis early in patients with GI bleeding.

Methods

This retrospective study involved patients who visited for complaining of GI bleeding symptoms. Initial lactate levels were measured upon arrival at the ED and measured again 3 h later after performing initial resuscitation. And 3-h lactate clearance was calculated. Lactate and 3-h lactate clearance for predicting outcomes were evaluated by the area under the receiver operating characteristic (AUROC) curve.

Results

A total of 104 patients were enrolled and 21 patients (20.2%) died in the hospital. Multivariate logistic regression showed that 3-h lactate clearance was a significant predictor of in-hospital mortality. The AUROC of 3-h lactate clearance for predicting in-hospital mortality was 0.756. The sensitivity and specificity were 66.67% and 75.90%. On combining lactate clearance, total bilirubin, and PTT, the AUROC was 0.899 for predicting in-hospital mortality.

Conclusions

This study validated that lactate clearance at three-hourly intervals is useful for early prediction of mortality and prognosis in patients with GI bleeding. It is important to perform not only an initial lactate measurement, but also a follow-up lactate measurement after initial resuscitation to check the lactate clearance.

Sostres C, Lanas A (2011) Epidemiology and demographics of upper gastrointestinal bleeding: prevalence, incidence, and mortality. Gastrointest Endosc Clin N Am 21:567–581. https://doi.org/10.1016/j.giec.2011.07.004CrossRefPubMed

Button LA, Roberts SE, Evans PA et al (2011) Hospitalized incidence and case fatality for upper gastrointestinal bleeding from 1999 to 2007: a record linkage study. Aliment Pharmacol Ther 33:64–76. https://doi.org/10.1111/j.1365-2036.2010.04495.xCrossRefPubMed

Baradarian R, Ramdhaney S, Chapalamadugu R PA et al (2004) Early intensive resuscitation of patients with upper gastrointestinal bleeding decreases mortality. Am J Gastroenterol 99:619–622. https://doi.org/10.1111/j.1572-0241.2004.04073.xCrossRefPubMed

Barkun AN, Bardou M, Kuipers EJ PA et al (2010) International consensus recommendations on the management of patients with nonvariceal upper gastrointestinal bleeding. Ann Intern Med 152:101–113. https://doi.org/10.7326/0003-4819-152-2-201001190-00009CrossRefPubMed

Laine L, Yang H, Chang SC, Datto C (2012) Trends for incidence of hospitalization and death due to GI complications in the United States from 2001 to 2009. Am J Gastroenterol 107:1190–1195;quiz 1196. https://doi.org/10.1038/ajg.2012.168

Peery AF, Crockett SD, Murphy CC PA et al (2019) Burden and cost of gastrointestinal, liver, and pancreatic diseases in the United States: update 2018. Gastroenterology 156:254-272.e211. https://doi.org/10.1053/j.gastro.2018.08.063CrossRefPubMed

Service WHIRaA (2021) Health insurance review and assessment service Wonju: Health Insurance Review and Assessment Service. http://opendata.hira.or.kr/op/opc/olap4thDsInfo.do

Shi ZX, Yang J, Liang HW et al (2017) Emergency transcatheter arterial embolization for massive gastrointestinal arterial hemorrhage. Medicine (Baltimore) 96:e9437. https://doi.org/10.1097/md.0000000000009437CrossRefPubMed

Shrestha MP, Borgstrom M, Trowers EA (2018) Elevated lactate level predicts intensive care unit admissions, endoscopies and transfusions in patients with acute gastrointestinal bleeding. Clin Exp Gastroenterol 11:185–192. https://doi.org/10.2147/ceg.S162703CrossRefPubMedPubMedCentral

10.

Berger M, Divilov V, Teressa G (2019) Lactic acid is an independent predictor of mortality and improves the predictive value of existing risk scores in patients presenting with acute gastrointestinal bleeding. Gastroenterology Res 12:1–7. https://doi.org/10.14740/gr1085w

11.

Gulen M, Satar S, Tas A et al (2019) Lactate level predicts mortality in patients with upper gastrointestinal bleeding. Gastroenterol Res Pract 2019:5048078. https://doi.org/10.1155/2019/5048078CrossRefPubMedPubMedCentral

12.

Lavery RF, Livingston DH, Tortella BJ et al (2000) The utility of venous lactate to triage injured patients in the trauma center. J Am Coll Surg 190:656–664. https://doi.org/10.1016/s1072-7515(00)00271-4CrossRefPubMed

13.

Vandromme MJ, Griffin RL, Weinberg JA et al (2010) Lactate is a better predictor than systolic blood pressure for determining blood requirement and mortality: could prehospital measures improve trauma triage? J Am Coll Surg 210(861–867):867–869. https://doi.org/10.1016/j.jamcollsurg.2010.01.012CrossRef

14.

Mikkelsen ME, Miltiades AN, Gaieski DF et al (2009) Serum lactate is associated with mortality in severe sepsis independent of organ failure and shock. Crit Care Med 37:1670–1677. https://doi.org/10.1097/CCM.0b013e31819fcf68CrossRefPubMed

15.

Musikatavorn K, Thepnimitra S, Komindr A et al (2015) Venous lactate in predicting the need for intensive care unit and mortality among nonelderly sepsis patients with stable hemodynamic. Am J Emerg Med 33:925–930. https://doi.org/10.1016/j.ajem.2015.04.010CrossRefPubMed

16.

Hajian-Tilaki K (2013) Receiver operating characteristic (ROC) curve analysis for medical diagnostic test evaluation. Caspian J Intern Med 4:627–635PubMedPubMedCentral

17.

Perkins NJ, Schisterman EF (2006) The inconsistency of “optimal” cutpoints obtained using two criteria based on the receiver operating characteristic curve. Am J Epidemiol 163:670–675. https://doi.org/10.1093/aje/kwj063CrossRefPubMed

18.

Wada T, Hagiwara A, Uemura T et al (2016) Early lactate clearance for predicting active bleeding in critically ill patients with acute upper gastrointestinal bleeding: a retrospective study. Intern Emerg Med 11:737–743. https://doi.org/10.1007/s11739-016-1392-zCrossRefPubMed

19.

Liang PS, Saltzman JR (2014) A national survey on the initial management of upper gastrointestinal bleeding. J Clin Gastroenterol 48:e93-98. https://doi.org/10.1097/mcg.0000000000000095CrossRefPubMed

20.

Shafaghi A, Gharibpoor F, Mahdipour Z, Samadani AA (2019) Comparison of three risk scores to predict outcomes in upper gastrointestinal bleeding; modifying Glasgow-Blatchford with albumin. Rom J Intern Med 57:322–333. https://doi.org/10.2478/rjim-2019-0016CrossRefPubMed

21.

Laine L, Shah A (2010) Randomized trial of urgent vs. elective colonoscopy in patients hospitalized with lower GI bleeding. Am J Gastroenterol 105:2636–2641;quiz 2642. https://doi.org/10.1038/ajg.2010.277

22.

Verghese A, Charlton B, Kassirer JP et al (2015) Inadequacies of physical examination as a cause of medical errors and adverse events: a collection of vignettes. Am J Med 128:1322-1324.e1323. https://doi.org/10.1016/j.amjmed.2015.06.004CrossRefPubMed

23.

Reilly BM (2003) Physical examination in the care of medical inpatients: an observational study. Lancet 362:1100–1105. https://doi.org/10.1016/s0140-6736(03)14464-9CrossRefPubMed

24.

Kim D, Ha YR, Ahn JH et al (2019) Validation of Glasgow-Blatchford score, Pre-Rockall score, and AIMS65 score to predict active bleeding in patients with upper gastrointestinal bleeding in normotensive patients and suggestion for developing new predictors. J Korean Soc Emerg Med 30:401–410

25.

van Leerdam ME (2008) Epidemiology of acute upper gastrointestinal bleeding. Best Pract Res Clin Gastroenterol 22:209–224. https://doi.org/10.1016/j.bpg.2007.10.011CrossRefPubMed

26.

del Olmo JA, Peña A, Serra MA et al (2000) Predictors of morbidity and mortality after the first episode of upper gastrointestinal bleeding in liver cirrhosis. J Hepatol 32:19–24. https://doi.org/10.1016/s0168-8278(01)68827-5CrossRefPubMed

27.

Afessa B, Kubilis PS (2000) Upper gastrointestinal bleeding in patients with hepatic cirrhosis: clinical course and mortality prediction. Am J Gastroenterol 95:484–489. https://doi.org/10.1111/j.1572-0241.2000.01772.xCrossRefPubMed

28.

Kumar AS, Sibia RS (2015) Predictors of in-hospital mortality among patients presenting with variceal gastrointestinal bleeding. Saudi J Gastroenterol 21:43–46. https://doi.org/10.4103/1319-3767.151226CrossRefPubMedPubMedCentral

29.

Nelson DP, King CE, Dodd SL, Schumacker PT (1985) Cain SM (1987) Systemic and intestinal limits of O2 extraction in the dog. J Appl Physiol 63:387–394. https://doi.org/10.1152/jappl.1987.63.1.387CrossRef

30.

James JH, Luchette FA, McCarter FD, Fischer JE (1999) Lactate is an unreliable indicator of tissue hypoxia in injury or sepsis. Lancet 354:505–508. https://doi.org/10.1016/s0140-6736(98)91132-1CrossRefPubMed

31.

Luchette FA, Friend LA, Brown CC et al (1998) Increased skeletal muscle Na+, K+-ATPase activity as a cause of increased lactate production after hemorrhagic shock. J Trauma 44:796–801; discussion 801–793. https://doi.org/10.1097/00005373-199805000-00010

32.

McCarter FD, Evans JA, Luchette FA et al (2000) Concurrent reduction of glycogenolysis, glycolysis, and NA(+)/K(+) pump activity after hemorrhagic shock. Curr Surg 57:639. https://doi.org/10.1016/s0149-7944(00)00362-7CrossRefPubMed

33.

Brooke M, Yeung L, Miraflor E et al (2016) Lactate predicts massive transfusion in hemodynamically normal patients. J Surg Res 204:139–144. https://doi.org/10.1016/j.jss.2016.04.015CrossRefPubMed

34.

Sohn CH, Kim YJ, Seo DW et al (2018) Blood lactate concentration and shock index associated with massive transfusion in emergency department patients with primary postpartum haemorrhage. Br J Anaesth 121:378–383. https://doi.org/10.1016/j.bja.2018.04.039CrossRefPubMed

35.

El-Menyar A, Abdelrahman H, Al-Thani H et al (2020) The FASILA score: a novel bio-clinical score to predict massive blood transfusion in patients with abdominal trauma. World J Surg 44:1126–1136. https://doi.org/10.1007/s00268-019-05289-0CrossRefPubMed

Titel: Early lactate clearance for predicting outcomes in patients with gastrointestinal bleeding
verfasst von: Keon Kim
Dong Hoon Lee
Duk Hee Lee
Yoon Hee Choi
Sung Jin Bae
Publikationsdatum: 13.10.2022
Verlag: Springer International Publishing
Erschienen in: Irish Journal of Medical Science (1971 -) / Ausgabe 4/2023
Print ISSN: 0021-1265
Elektronische ISSN: 1863-4362
DOI: https://doi.org/10.1007/s11845-022-03185-6

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Early lactate clearance for predicting outcomes in patients with gastrointestinal bleeding