Lactate clearance predicts outcome after major trauma

Introduction: To determine a correlation between lactate clearance within 48 h and survival in trauma patients at a Level I trauma centre in a developing country and compare to previous international lactate clearance studies. Methods: We conducted a retrospective study of a prospectively collected database at a Level I trauma centre from March 2007 to November 2010. Patients of all ages were included. Metabolic parameters from initial arterial blood gas were measured in all patients, an abnormal lactate being defined as > 2.5 mmol/L. A subgroup analysis of blunt versus penetrating injury was performed. Results: Of the 657 patients in the database, 493 had complete lactate data. The survival rate of patients with lactate values <2.5 mmol/L was 88%. Of the patients with high lactate levels that cleared within 24 and 48 h the survival rates were 81% and 71%, respectively. The survival rate amongst patients not achieving a normal lactate within 48 h was 46% but was higher in those with penetrating as opposed to blunt injury (67% versus 38%). The overall survival was 81%. Conclusion: The present results confirm previous studies showing that prolonged lactate clearance predicts increased mortality in severely injured trauma patients. Thus, the measurements of arterial serum lactate trends are simple and effective predictors of outcome.