Serum lactate and base deficit as predictors of mortality and morbidity

Farah Husain, Matthew J. Martin, Philip S. Mullenix, Scott R. Steele, David C. Elliott

Research output: Contribution to journalArticle

304 Citations (Scopus)

Abstract

Objectives: To determine whether lactate levels and base deficits in critically ill surgical intensive care unit (SICU) patients correlate and whether either measure is a significant indicator of mortality and morbidity. Methods: A review was made of 137 SICU patients who had serial lactate and blood gas measurements. Patients were stratified by absolute lactate and base deficit values as well as time to lactate clearance. Results: Initial and 24-hour lactate level was significantly elevated in nonsurvivors versus survivors (P = 0.002). Initial base deficit was not significantly different; 24-hour base deficit did achieve statistical significance (P = 0.02). Subgroup analysis among trauma patients (n = 36) and major abdominal surgery (n = 101) confirmed the significant correlation between lactate levels and survival. There was poor correlation between initial and 24-hour lactate and base deficit among all patients (r = -0.3 and -0.5). Mortality if lactate normalized within 24 hours was 10%, compared with 24% for >48 hours and 67% if lactate failed to normalize. Physical status at discharge was related to initial lactate (P = 0.05), as well as to lactate clearance time (P = 0.01). Conclusions: Elevated initial and 24-hour lactate levels are significantly correlated with mortality and appear to be superior to corresponding base deficit levels. Lactate clearance time may be used to predict mortality and is associated with outcome at discharge. Initial base deficit is a poor predictor of mortality and did not correlate with lactate levels except in trauma nonsurvivors. In addition to being used as an endpoint for resuscitation, lactate may be predictive of certain morbidities and patient outcome at discharge.

Original languageEnglish (US)
Pages (from-to)485-491
Number of pages7
JournalAmerican Journal of Surgery
Volume185
Issue number5
DOIs
StatePublished - May 1 2003
Externally publishedYes

Fingerprint

Lactic Acid
Morbidity
Mortality
Serum
Critical Care
Intensive Care Units
Wounds and Injuries
Critical Illness
Resuscitation
Survivors
Gases

Keywords

  • Base deficit
  • Morbidity
  • Mortality
  • Serum lactate
  • Surgical intensive care unit

ASJC Scopus subject areas

  • Surgery

Cite this

Serum lactate and base deficit as predictors of mortality and morbidity. / Husain, Farah; Martin, Matthew J.; Mullenix, Philip S.; Steele, Scott R.; Elliott, David C.

In: American Journal of Surgery, Vol. 185, No. 5, 01.05.2003, p. 485-491.

Research output: Contribution to journalArticle

Husain, Farah ; Martin, Matthew J. ; Mullenix, Philip S. ; Steele, Scott R. ; Elliott, David C. / Serum lactate and base deficit as predictors of mortality and morbidity. In: American Journal of Surgery. 2003 ; Vol. 185, No. 5. pp. 485-491.
@article{4d6ecda89def44e88eb3747ed7f4a255,
title = "Serum lactate and base deficit as predictors of mortality and morbidity",
abstract = "Objectives: To determine whether lactate levels and base deficits in critically ill surgical intensive care unit (SICU) patients correlate and whether either measure is a significant indicator of mortality and morbidity. Methods: A review was made of 137 SICU patients who had serial lactate and blood gas measurements. Patients were stratified by absolute lactate and base deficit values as well as time to lactate clearance. Results: Initial and 24-hour lactate level was significantly elevated in nonsurvivors versus survivors (P = 0.002). Initial base deficit was not significantly different; 24-hour base deficit did achieve statistical significance (P = 0.02). Subgroup analysis among trauma patients (n = 36) and major abdominal surgery (n = 101) confirmed the significant correlation between lactate levels and survival. There was poor correlation between initial and 24-hour lactate and base deficit among all patients (r = -0.3 and -0.5). Mortality if lactate normalized within 24 hours was 10{\%}, compared with 24{\%} for >48 hours and 67{\%} if lactate failed to normalize. Physical status at discharge was related to initial lactate (P = 0.05), as well as to lactate clearance time (P = 0.01). Conclusions: Elevated initial and 24-hour lactate levels are significantly correlated with mortality and appear to be superior to corresponding base deficit levels. Lactate clearance time may be used to predict mortality and is associated with outcome at discharge. Initial base deficit is a poor predictor of mortality and did not correlate with lactate levels except in trauma nonsurvivors. In addition to being used as an endpoint for resuscitation, lactate may be predictive of certain morbidities and patient outcome at discharge.",
keywords = "Base deficit, Morbidity, Mortality, Serum lactate, Surgical intensive care unit",
author = "Farah Husain and Martin, {Matthew J.} and Mullenix, {Philip S.} and Steele, {Scott R.} and Elliott, {David C.}",
year = "2003",
month = "5",
day = "1",
doi = "10.1016/S0002-9610(03)00044-8",
language = "English (US)",
volume = "185",
pages = "485--491",
journal = "American Journal of Surgery",
issn = "0002-9610",
publisher = "Elsevier Inc.",
number = "5",

}

TY - JOUR

T1 - Serum lactate and base deficit as predictors of mortality and morbidity

AU - Husain, Farah

AU - Martin, Matthew J.

AU - Mullenix, Philip S.

AU - Steele, Scott R.

AU - Elliott, David C.

PY - 2003/5/1

Y1 - 2003/5/1

N2 - Objectives: To determine whether lactate levels and base deficits in critically ill surgical intensive care unit (SICU) patients correlate and whether either measure is a significant indicator of mortality and morbidity. Methods: A review was made of 137 SICU patients who had serial lactate and blood gas measurements. Patients were stratified by absolute lactate and base deficit values as well as time to lactate clearance. Results: Initial and 24-hour lactate level was significantly elevated in nonsurvivors versus survivors (P = 0.002). Initial base deficit was not significantly different; 24-hour base deficit did achieve statistical significance (P = 0.02). Subgroup analysis among trauma patients (n = 36) and major abdominal surgery (n = 101) confirmed the significant correlation between lactate levels and survival. There was poor correlation between initial and 24-hour lactate and base deficit among all patients (r = -0.3 and -0.5). Mortality if lactate normalized within 24 hours was 10%, compared with 24% for >48 hours and 67% if lactate failed to normalize. Physical status at discharge was related to initial lactate (P = 0.05), as well as to lactate clearance time (P = 0.01). Conclusions: Elevated initial and 24-hour lactate levels are significantly correlated with mortality and appear to be superior to corresponding base deficit levels. Lactate clearance time may be used to predict mortality and is associated with outcome at discharge. Initial base deficit is a poor predictor of mortality and did not correlate with lactate levels except in trauma nonsurvivors. In addition to being used as an endpoint for resuscitation, lactate may be predictive of certain morbidities and patient outcome at discharge.

AB - Objectives: To determine whether lactate levels and base deficits in critically ill surgical intensive care unit (SICU) patients correlate and whether either measure is a significant indicator of mortality and morbidity. Methods: A review was made of 137 SICU patients who had serial lactate and blood gas measurements. Patients were stratified by absolute lactate and base deficit values as well as time to lactate clearance. Results: Initial and 24-hour lactate level was significantly elevated in nonsurvivors versus survivors (P = 0.002). Initial base deficit was not significantly different; 24-hour base deficit did achieve statistical significance (P = 0.02). Subgroup analysis among trauma patients (n = 36) and major abdominal surgery (n = 101) confirmed the significant correlation between lactate levels and survival. There was poor correlation between initial and 24-hour lactate and base deficit among all patients (r = -0.3 and -0.5). Mortality if lactate normalized within 24 hours was 10%, compared with 24% for >48 hours and 67% if lactate failed to normalize. Physical status at discharge was related to initial lactate (P = 0.05), as well as to lactate clearance time (P = 0.01). Conclusions: Elevated initial and 24-hour lactate levels are significantly correlated with mortality and appear to be superior to corresponding base deficit levels. Lactate clearance time may be used to predict mortality and is associated with outcome at discharge. Initial base deficit is a poor predictor of mortality and did not correlate with lactate levels except in trauma nonsurvivors. In addition to being used as an endpoint for resuscitation, lactate may be predictive of certain morbidities and patient outcome at discharge.

KW - Base deficit

KW - Morbidity

KW - Mortality

KW - Serum lactate

KW - Surgical intensive care unit

UR - http://www.scopus.com/inward/record.url?scp=0037408227&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=0037408227&partnerID=8YFLogxK

U2 - 10.1016/S0002-9610(03)00044-8

DO - 10.1016/S0002-9610(03)00044-8

M3 - Article

VL - 185

SP - 485

EP - 491

JO - American Journal of Surgery

JF - American Journal of Surgery

SN - 0002-9610

IS - 5

ER -