title: Predicting the Occurrence of Hypotension in Stable Patients With Nonvariceal Upper Gastrointestinal Bleeding: Point-of-Care Lactate Testing.
abstract: OBJECTIVE
  It is difficult to assess risk in normotensive patients with upper gastrointestinal bleeding. The aim of this study was to evaluate whether the initial lactate value can predict the in-hospital occurrence of hypotension in stable patients with acute nonvariceal upper gastrointestinal bleeding.
  
  
  METHODS
  Retrospective, observational, single-center study.
  
  
  METHODS
  Emergency department of a tertiary-care, university-affiliated hospital during a 5-year period.
  
  
  METHODS
  Medical records of 3,489 patients with acute upper gastrointestinal bleeding who were normotensive at presentation to the emergency department. We analyzed the ability of point-of-care testing of lactate at emergency department admission to predict hypotension development (defined as systolic blood pressure <90 mm Hg) within 24 hours after emergency department admission.
  
  
  METHODS
  None.
  
  
  RESULTS
  Of the 1,003 patients with acute nonvariceal upper gastrointestinal bleeding, 157 patients experienced hypotension within 24 hours. Lactate was independently associated with hypotension development (odds ratio, 1.6; 95% CI, 1.4-1.7), and the risk of hypotension significantly increased as the lactate increased from 2.5-4.9 mmol/L (odds ratio, 2.2) to 5.0-7.4 mmol/L (odds ratio, 4.0) and to greater than or equal to 7.5 mmol/L (odds ratio, 39.2) (p<0.001). Lactate elevation (≥2.5 mmol/L) was associated with 90% specificity and an 84% negative predictive value for hypotension development. When the lactate levels were greater than 5.0 mmol/L, the specificity and negative predictive value increased to 98% and 87%, respectively.
  
  
  CONCLUSIONS
  Point-of-care testing of lactate can predict in-hospital occurrence of hypotension in stable patients with acute nonvariceal upper gastrointestinal bleeding. However, subsequently, prospective validate research will be required to clarify this.
authors.affiliation: 1Department of Emergency Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea. 2Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
authors.forename: Byuk Sung
authors.initials: BS
authors.lastname: Ko
authors.forename: Won Young
authors.initials: WY
authors.lastname: Kim
authors.forename: Seung Mok
authors.initials: SM
authors.lastname: Ryoo
authors.forename: Shin
authors.initials: S
authors.lastname: Ahn
authors.forename: Chang Hwan
authors.initials: CH
authors.lastname: Sohn
authors.forename: Dong Woo
authors.initials: DW
authors.lastname: Seo
authors.forename: Yoon-Seon
authors.initials: YS
authors.lastname: Lee
authors.forename: Kyoung Soo
authors.initials: KS
authors.lastname: Lim
authors.forename: Hwoon-Yong
authors.initials: HY
authors.lastname: Jung
mesh_terms: D000208:Acute Disease; D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers / Q000097:blood; D015331:Cohort Studies; D004636:Emergency Service, Hospital; D004932:Esophageal and Gastric Varices; D005260:Female; D005500:Follow-Up Studies; D006471:Gastrointestinal Hemorrhage / Q000150:complications / Q000175:diagnosis* / Q000401:mortality / Q000628:therapy; D017052:Hospital Mortality; D006785:Hospitals, University; D006801:Humans; D007022:Hypotension / Q000175:diagnosis* / Q000209:etiology / Q000401:mortality / Q000628:therapy; D007773:Lactates / Q000097:blood*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D019095:Point-of-Care Systems; D011237:Predictive Value of Tests; D012372:ROC Curve; D012189:Retrospective Studies; D012720:Severity of Illness Index; D018709:Statistics, Nonparametric; D015996:Survival Rate; D062606:Tertiary Care Centers
chemical_list: D015415:Biomarkers; D007773:Lactates