Capillary lactate concentration on admission of normotensive trauma patients: a prospective study.
BACKGROUND
Elevated serum blood lactate is an indicator of on-going bleeding in severe trauma patients. Point-of-care (POC) capillary lactate measurement devices may be useful to rapidly assess lactate concentration at the bedside. The aim of this study was to test the diagnostic performance of capillary lactate to predict significant transfusion in normotensive trauma patients.


METHODS
We conducted a prospective observational study in one level-I trauma centre. From August 2011 to February 2013, 120 consecutive adult patients with systolic blood pressure (SBP) higher than 90 mmHg were included. Capillary lactate was measured on admission in the trauma bay. The primary outcome was defined as a significant transfusion within the first 48 h. Diagnostic performance was determined using receiver operating characteristic (ROC) curve analysis. We also tested the agreement between capillary lactate and blood lactate concentrations using Bland and Altman analysis.


RESULTS
Of the 120 normotensive trauma patients, 30 (25 %) required at least one unit of packed red blood cells (RBC) and 12 (10 %) patients received at least four RBC within the first 48 h. All patients with significant RBC transfusion had capillary lactate higher than 3.5 mmol/l. The area under the ROC curve of capillary lactate on admission to predict transfusion of at least 4 RBC units was 0.68 [95 % CI 0.58 - 0.78]. The average bias between capillary and blood lactate measurements was 2.4 mmol/l with a standard deviation of 3.0 mmol/l (n = 60 patients).


CONCLUSIONS
Although a significant association was found between POC lactate concentration and transfusion requirements, the diagnostic performance of capillary lactate measurements was poor. Due to large disagreement between capillary lactate and blood lactate, capillary lactate cannot be considered in the clinical setting.


BACKGROUND
ClinicalTrials.gov, No. NCT01793428 .
Pôle Anesthesie Reanimation, CHU Grenoble Alpes, F-38000, Grenoble, France. PBouzat@chu-grenoble.fr.|University Grenoble Alpes, F-38000, Grenoble, France. PBouzat@chu-grenoble.fr.|INSERM U1216, F-38000, Grenoble, France. PBouzat@chu-grenoble.fr.
Pierre
P
Bouzat
Pôle Anesthesie Reanimation, CHU Grenoble Alpes, F-38000, Grenoble, France.|University Grenoble Alpes, F-38000, Grenoble, France.
Clotilde
C
Schilte
Pôle Anesthesie Reanimation, CHU Grenoble Alpes, F-38000, Grenoble, France.
Marc
M
Vinclair
Pôle Anesthesie Reanimation, CHU Grenoble Alpes, F-38000, Grenoble, France.
Pauline
P
Manhes
Pôle Anesthesie Reanimation, CHU Grenoble Alpes, F-38000, Grenoble, France.
Julien
J
Brun
Centre d'investigation clinique, CHU Grenoble Alpes, F-38000, Grenoble, France.
Jean-Luc
JL
Bosson
Pôle Anesthesie Reanimation, CHU Grenoble Alpes, F-38000, Grenoble, France.|University Grenoble Alpes, F-38000, Grenoble, France.|INSERM U1216, F-38000, Grenoble, France.
Jean-François
JF
Payen
D000328:Adult; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D001794:Blood Pressure / Q000502:physiology; D017707:Erythrocyte Transfusion; D005500:Follow-Up Studies; D006470:Hemorrhage / Q000097:blood / Q000209:etiology / Q000628:therapy; D007297:Inpatients; D019344:Lactic Acid / Q000097:blood; D011446:Prospective Studies; D012372:ROC Curve; D014193:Trauma Centers; D015599:Trauma Severity Indices; D014947:Wounds and Injuries / Q000097:blood / Q000150:complications / Q000175:diagnosis
D019344:Lactic Acid
Lactate; Point-of-care; Severe trauma; Transfusion