title: Lactic acidosis is associated with multiple organ failure and need for ventilator support in patients with severe hemorrhage from trauma.
abstract: OBJECTIVE
  Lactate is a biomarker for hypoperfusion and subsequent resuscitation in trauma. It is also a predictor of mortality, but few studies have correlated lactate levels with relevant morbidities after trauma.
  
  
  METHODS
  A retrospective review was performed of severely injured trauma patients entered into the Trauma Registry of the German Society for Trauma Surgery (TR-DGU) between 2002 and 2008. Adults requiring intensive care were categorized into two groups: lactate and no lactate. The lactate group had three subgroups: normal, elevated, and high lactate. Mean multiple organ failure (MOF) rates and composite endpoint of time (days) to complete organ failure resolution (CTCOFR) for 14 and 21 days and ventilator-free days (VFD) were compared, as well as other endpoints.
  
  
  RESULTS
  We analyzed 2,949 patients, of which 1,199 had lactate measurements. The percentage of patients with MOF increased in each higher lactate subgroup (p < 0.001), as did the mean CTCOFR14 and CTCOFR21 scores (p < 0.001 and < 0.001, respectively). Conversely, the mean VFD decreased in each higher lactate subgroup (p < 0.001). Thus, patients in the elevated and high lactate subgroups had greater MOF rates; required more days, on average, to resolve organ failure; and required more days of ventilator support than patients in the normal lactate subgroup.
  
  
  CONCLUSIONS
  Elevated blood lactate levels from trauma were closely correlated with worse outcomes. Thus, lactate shows promise as a biomarker for resuscitation as well as a predictor of mortality. Furthermore, this study supports its use in critical care trials as an outcome measure.
authors.affiliation: Institute for Research in Operative Medicine (IFOM), Medical Faculty, University Witten/Herdecke, Cologne Medical Center, Ostmerheimer Str. 200, 51109, Cologne, Germany. rolf.lefering@uni-wh.de.
authors.forename: R
authors.initials: R
authors.lastname: Lefering
authors.affiliation: Institute for Research in Operative Medicine (IFOM), Medical Faculty, University Witten/Herdecke, Cologne Medical Center, Ostmerheimer Str. 200, 51109, Cologne, Germany. dzielske@sangart.com.|Sangart, Inc., San Diego, CA, USA. dzielske@sangart.com.
authors.forename: D
authors.initials: D
authors.lastname: Zielske
authors.affiliation: Department of Trauma and Orthopedic Surgery, University Witten/Herdecke, Cologne Merheim Medical Center, Cologne, Germany. bouillonb@kliniken-koeln.de.
authors.forename: B
authors.initials: B
authors.lastname: Bouillon
authors.affiliation: Harvard Medical School, Boston, MA, USA. cjhauser@bidmc.harvard.edu.
authors.forename: C
authors.initials: C
authors.lastname: Hauser
authors.affiliation: Sangart, Inc., San Diego, CA, USA. hlevy@sangart.com.
authors.forename: H
authors.initials: H
authors.lastname: Levy
keywords: Hemorrhage; Lactate; Morbidity; Mortality; Multiple organ failure; Ventilator-free days
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