Admission lactate level and the APACHE II score are the most useful predictors of prognosis following torso trauma.
BACKGROUND
Markers of dysoxic metabolism and scoring systems for triage have been widely used in critically injured patients. However, so far, no model is sufficiently reliable to predict the outcome in trauma victims. The purposes of the present study, therefore, were to determine whether a correlation exits between the main trauma scoring systems and the markers of dysoxic metabolism. Moreover, to assess if any of the admission parameters can be used to indicate outcome.


METHODS
Sixty-four patients were included in this study. Admission data, including arterial lactate level, base deficit (BD), pH, revised trauma score (RTS), injury severity score (ISS), shock index (SI), and Acute Physiology and Chronic Health Evaluation (APACHE II), were collected and analysed by logistic regression analysis. Degree of association between continuous variables were calculated by either Pearson's or Spearman's correlation coefficient, where applicable. The dependence of lactate on two or more other variables was evaluated by multiple linear regression analysis.


RESULTS
Logistic regression analysis showed that the fatal outcome following major torso trauma was principally associated with the APACHE II score and lactate. The specificity and the sensitivity of this logistic regression model was 94.6 and 79.2%, respectively. According to standardised linear regression coefficients, BD was the best single predictor of lactate, and APACHE II added a small amount of predictive power. The proportion of total variation in lactate level explained by base deficit, APACHE II and age is R2=85.2%.


CONCLUSIONS
APACHE II score and the arterial lactate level are the most important determinants of clinical outcome in critically injured patients. A correlation exits between lactate and APACHE II and between lactate and base deficit.
Aslar
Ahmet Kessaf
AK
Department of Surgery, Ankara Numune Hospital, ehit cetin Görgü S. Ugur A. 17/3, Maltepe, Ankara 06570, Turkey. kessafaslar@hotmail.com
Kuzu
Mehmet Ayhan
MA
Elhan
Atilla Halil
AH
Tanik
Adil
A
Hengirmen
Suleyman
S
D018806:APACHE; D000328:Adult; D015415:Biomarkers / Q000097:blood; D005260:Female; D006801:Humans; D007773:Lactates / Q000097:blood*; D008297:Male; D010343:Patient Admission; D011379:Prognosis; D012044:Regression Analysis; D012680:Sensitivity and Specificity; D014218:Triage / Q000379:methods; D014947:Wounds and Injuries / Q000097:blood / Q000401:mortality*
D015415:Biomarkers; D007773:Lactates