Serial lactate and admission SOFA scores in trauma: an analysis of predictive value in 724 patients with and without traumatic brain injury

被引:32
作者
Duebendorfer, C. [1 ,2 ]
Billeter, A. T. [2 ,3 ]
Seifert, B. [4 ]
Keel, M. [5 ]
Turina, M. [6 ]
机构
[1] Kantonsspital Winterthur, Dept Anesthesiol, CH-8401 Winterthur, Switzerland
[2] Univ Zurich Hosp, Div Trauma Surg, Dept Surg, CH-8091 Zurich, Switzerland
[3] Univ Louisville, Price Inst Surg Res, Sch Med, Louisville, KY 40202 USA
[4] Univ Zurich, Biostat Unit, Inst Social & Prevent Med, CH-8001 Zurich, Switzerland
[5] Inselspital Bern, Dept Orthopaed Surg, Univ Hosp Bern, CH-3002 Bern, Switzerland
[6] Cleveland Clin Fdn, Dept Colorectal Surg, Cleveland, OH 44195 USA
关键词
Trauma; Infection; Sepsis; Lactate; Base excess; SOFA score; GLASGOW COMA SCALE; ORGAN FAILURE; BASE DEFICIT; OCCULT HYPOPERFUSION; SERUM LACTATE; MORTALITY; SEPSIS; SURVIVAL; MULTICENTER; CLEARANCE;
D O I
10.1007/s00068-012-0212-z
中图分类号
R4 [临床医学];
学科分类号
1002 ; 100602 ;
摘要
Objective Arterial lactate, base excess (BE), lactate clearance, and Sequential Organ Failure Assessment (SOFA) score have been shown to correlate with outcome in severely injured patients. The goal of the present study was to separately assess their predictive value in patients suffering from traumatic brain injury (TBI) as opposed to patients suffering from injuries not related to the brain. Materials and methods A total of 724 adult trauma patients with an Injury Severity Score (ISS) >= 16 were grouped into patients without TBI (non-TBI), patients with isolated TBI (isolated TBI), and patients with a combination of TBI and non-TBI injuries (combined injuries). The predictive value of the above parameters was then analyzed using both uni- and multivariate analyses. Results The mean age of the patients was 39 years (77 % males), with a mean ISS of 32 (range 16-75). Mortality ranged from 14 % (non-TBI) to 24 % (combined injuries). Admission and serial lactate/BE values were higher in non-survivors of all groups (all p < 0.01), but not in patients with isolated TBI. Admission SOFA scores were highest in non-survivors of all groups (p = 0.023); subsequently septic patients also showed elevated SOFA scores (p < 0.01), except those with isolated TBI. In this group, SOFA score was the only parameter which showed significant differences between survivors and non-survivors. Receiver operating characteristic (ROC) analysis revealed lactate to be the best overall predictor for increased mortality and further septic complications, irrespective of the leading injury. Conclusion Lactate showed the best performance in predicting sepsis or death in all trauma patients except those with isolated TBI, and the differences were greatest in patients with substantial bleeding. Following isolated TBI, SOFA score was the only parameter which could differentiate survivors from non-survivors on admission, although the SOFA score, too, was not an independent predictor of death following multivariate analysis.
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收藏
页码:25 / 34
页数:10
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