Lactate as an Early Predictor for Early Massive Transfusion in Trauma Patients: A Retrospective Study

Abstract

Objective Transfusion is a key treatment for patients with hemorrhage. Early massive transfusion (EMT) is defined as transfusion of 10 or more units of red blood cells (RBC) within the first 6 hours. We attempted to determine whether metabolic markers can be used as predictors for EMT. Method We retrospectively reviewed outcomes in 71 patients who visited the emergency department within 12 hours after trauma and received at least 1 unit of RBC within 24 hours between January 2008 and June 2010. Results Of the 71 patients, 54 were male and 17 were female; their mean age was 50.3±17.7 years. Of these, 15 required EMT and 56 did not; these patients received 17.7±13.1 and 2.8±2.3 units of RBCs, respectively. There were significant differences between EMT and non-EMT groups in injury severity score (ISS; p=0.001), systolic blood pressure (SBP; p=0.010), base deficit (p=0.003), and lactate concentration (p=0.001). Logistic regression analysis showed that SBP <90 mmHg (odds ratio [OR] 11.71, 95% CI 1.83-74.77, p=0.009), ISS ≥25 (OR 23.39, 95% CI 1.87-293.23, p=0.015), and lactate ≥3.5 mmol/L (OR 6.99, 95% CI 1.10-44.33, p=0.039) were significant predictors of EMT. The area under the curve for ≥3.5 mmol/L lactate was 0.79 (p=0.001), with a sensitivity of 76.7% and a specificity of 67.8%. The 30-day mortality rate was significantly higher in patients with lactate ≥3.5 mmol/L than in those with lactate <3.5 mmol/L (p=0.002). Conclusion Lactate concentration is an important predictor of the need for EMT and should be considered in the initial phase of trauma resuscitation to prepare for massive transfusion.