[Measurement of lactic acid in multiple injury patients and its usefulness as a predictor of multiorgan failure and mortality].
BACKGROUND
The use of lactic acid as marker of occult hyperfusion and its relationship with multiorgan failure (MOF) and/or mortality is a subject of debate.


METHODS
A prospective study was conducted on multiple injury patients over 16 years of age in critical care areas. The lactic acid was measured at the beginning and at 24 hours of the trauma and associating it with the patient morbidity and mortality.


RESULTS
A total of 342 patients, with a mean injury severity score of 24.1, were included. The patients who survived had an initial, and 24 hours after the trauma, lactic acid of 27.8 mg/dl and 17.9 mg/dl, respectively, (normal values less than 22 mg/dl), increasing to 36.5mg/dl and 40.2mg/dl, respectively, in those who died. There were no differences between the initial lactic acid in patients with and without MOF, being increased at 24 hours in those who had MOF (17.8 vs 26.7). The patients with a lactic acid that got worse or remained abnormal at 24 hours had a higher mortality than those in which it remained the same or improved (25% - 17.1% vs 6.3% - 0.8%), with the percentage of patients with MOF also increasing (40.6% - 32.8% vs 14.9% - 11.1%). In haemodynamically stable patients, there was also a higher mortality when the lactic acid got worse or remained abnormal in the first 24 hours (23.8% - 19.2% vs 8.8% - 0%), as well as a higher percentage of MOF (38.1% - 26.9% vs 10.9% - 7.6%).


CONCLUSIONS
The lactic acid results in the first 24 hours of the multiple injury patient are associated with mortality and MOF, even when the patient is haemodynamically stable.
Servicio de cirugía general y del aparato digestivo, Corporació Sanitària Parc Taulí, Sabadell, Barcelona, España. sandra.montmany@gmail.com
Sandra
S
Montmany Vioque
Salvador
S
Navarro Soto
Pere
P
Rebasa Cladera
Alexis
A
Luna Aufroy
Carlos
C
Gómez Díaz
Heura
H
Llaquet Bayo
D000328:Adult; D006801:Humans; D019344:Lactic Acid / Q000097:blood*; D008875:Middle Aged; D009102:Multiple Organ Failure / Q000097:blood* / Q000209:etiology / Q000401:mortality*; D009104:Multiple Trauma / Q000097:blood* / Q000150:complications / Q000401:mortality*; D011237:Predictive Value of Tests
D019344:Lactic Acid