Correlation of Serum Lactate and Shock Index as Mortality Predictor in Polytrauma Patients: Serum Lactate and Shock Index in Polytrauma Patients

Noor us Sahar Siddiqui; Meer Ahmed; Sanober Sikhandar; Soonh Shakoor; Shahdil Zulfikar Memon; Muhammad Momin Khan; Saima Mushtaq

doi:10.54393/pjhs.v5i09.2205

Authors

Noor us Sahar Siddiqui Liaquat University of Medical and Health Sciences, Jamshoro, Pakistan
Meer Ahmed Jinnah Postgraduate Medical Centre, Karachi, Pakistan
Sanober Sikhandar Jinnah Postgraduate Medical Centre, Karachi, Pakistan
Soonh Shakoor Jinnah Postgraduate Medical Centre, Karachi, Pakistan
Shahdil Zulfikar Memon Regional Hospital Taullamore, Ireland
Muhammad Momin Khan Liaquat University of Medical and Health Sciences, Jamshoro, Pakistan
Saima Mushtaq Liaquat University of Medical and Health Sciences, Jamshoro, Pakistan

DOI:

https://doi.org/10.54393/pjhs.v5i09.2205

Keywords:

Polytraum, Serum Lactate, Shock Index, Mortality, Trauma Care, Biomarker

Abstract

In polytrauma patients, serum lactate and hypovolemic shock are critical biomarkers for prognosis and treatment guidance. Elevated lactate levels indicate tissue hypoperfusion and anaerobic metabolism, often correlating with increased mortality. Objective: To analyze the correlation between serum lactate levels and shock index as predictors of in-hospital mortality in polytrauma patients. Methods: A Cohort study was conducted from August 2022 to July 2023 at a single tertiary care hospital in Karachi. Patients were chosen via consecutive sampling techniques and included adult patients with polytrauma injuries (ISS ≥ 15) who survived at least 24 hours. Patients with a history of diabetes were excluded. The serum lactate levels and shock index at the time of admission and over the first 24 hours were the exposures while in-hospital mortality, was the primary outcome. Statistical analyses were conducted using Stata 16.0. Categorical variables were analyzed using the chi-square test. Multivariable logistic regression evaluated mortality risk, adjusting for age, ISS, and shock index. Results: The in-hospital mortality rate in the study was 6.4% with significant predictors of mortality included increasing age (47.05 vs. 27.62 years, p<0.001), higher Injury Severity Scores (ISS) (24 vs. 19, p= 0.02), and elevated shock index at admission (0.84 vs. 0.71, p<0.001). Lactate metrics were strongly associated with mortality, showing significant correlations. Conclusions: Higher serum lactate levels and shock index are strong predictors of mortality in polytrauma patients. Greater age and injury severity also contribute to poorer outcomes.

References

Alshiakh SM. Role of Serum Lactate as Prognostic Marker of Mortality Among Emergency Department Patients with Multiple Conditions: A Systematic Review. Sage Open Medicine. 2023 Jan; 11: 20503121221136401. doi: 10.1177/20503121221136401.

Woolum JA, Abner EL, Kelly A, Bastin ML, Morris PE, Flannery AH. Effect of Thiamine Administration On Lactate Clearance and Mortality in Patients with Septic Shock. Critical Care Medicine. 2018 Nov; 46(11): 1747-52. doi: 10.1097/CCM.0000000000003311.

Zeng Z, Huang R, Lin H, Peng H, Luo J, Ding N. Serum Lactate is an Indicator for Short-Term and Long-Term Mortality in Patients with Acute Pancreatitis. Digestive Diseases and Sciences. 2024 Apr: 1-2. doi: 10.1007/s10620-024-08419-4.

Callaway DW, Shapiro NI, Donnino MW, Baker C, Rosen CL. Serum Lactate and Base Deficit as Predictors of Mortality in Normotensive Elderly Blunt Trauma Patients. Journal of Trauma and Acute Care Surgery. 2009 Apr; 66(4): 1040-4. doi: 10.1097/TA.0b013e3181895e9e.

Guyette F, Suffoletto B, Castillo JL, Quintero J, Callaway C, Puyana JC. Prehospital Serum Lactate as A Predictor of Outcomes in Trauma Patients: A Retrospective Observational Study. Journal of Trauma and Acute Care Surgery. 2011 Apr; 70(4): 782-6. doi: 10.1097/TA.0b013e318210f5c9.

Weinberger J, Klompas M, Rhee C. What is the Utility of Measuring Lactate Levels in Patients with Sepsis and Septic Shock?. Inseminars in Respiratory and Critical Care Medicine 2021 Oct; 42(05): 650-661. doi: 10.1055/s-0041-1733915.

Gharipour A, Razavi R, Gharipour M, Mukasa D. Lactate/Albumin Ratio: An Early Prognostic Marker in Critically Ill Patients. The American Journal of Emergency Medicine. 2020 Oct; 38(10): 2088-95. doi: 10.1016/j.ajem.2020.06.067.

Freire Jorge P, Wieringa N, De Felice E, Van Der Horst IC, Oude Lansink A, Nijsten MW. The Association of Early Combined Lactate and Glucose Levels with Subsequent Renal and Liver Dysfunction and Hospital Mortality in Critically Ill Patients. Critical Care. 2017 Dec; 21: 1-1. doi: 10.1186/s13054-017-1785-z.

Hayashi Y, Endoh H, Kamimura N, Tamakawa T, Nitta M. Lactate Indices as Predictors of In-Hospital Mortality or 90-Day Survival After Admission to an Intensive Care Unit in Unselected Critically Ill Patients. Plos One. 2020 Mar; 15(3): E0229135. doi: 10.1371/journal.pone.0229135.

Iyengar KP, Venkatesan AS, Jain VK, Shashidhara MK, Elbana H, Botchu R. Risks in The Management of Polytrauma Patients: Clinical Insights. Orthopedic Research and Reviews. 2023 Dec: 27-38. doi: 10.2147/ORR.S340532.

Richards JE, Mazzeffi MA, Massey MS, Rock P, Galvagno SM, Scalea TM. The Bitter and The Sweet: Relationship of Lactate, Glucose, And Mortality After Severe Blunt Trauma. Anesthesia & Analgesia. 2021 Aug; 133(2): 455-61. doi: 10.1213/ANE.0000000000005335.

Shagana JA, Dhanraj M, Jain AR, Osa TN. Hypovolemic shock-A review. Drug Invention Today. 2018 Jul; 10(7): 1102-05.

Koch E, Lovett S, Nghiem T, Riggs RA, Rech MA. Shock index in the emergency department: utility and limitations. Open Access Emergency Medicine. 2019 Aug: 179-99. doi: 10.2147/OAEM.S178358.

Elbaih AH and Housseini AM. Validity of Shock Index, Modified Shock Index, Central Venous Pressure and Inferior Vena Cava Collapsibility Index in Evaluation of Intravascular Volume among Hypovolemic Egyptians Patients. American Journal of Diagnostic Imaging. 2018 Aug; 4(1): 5-13. doi: 10.5455/ajdi.20180318114502.

Cakir E, Bindal A, Yilmaz PO, Dogu C, Mutlu NM, Turan IO. The relationship of shock index, modified shock index, and age shock index with mortality in the intensive care unit. 2019; 26(10): 2148-53. doi: 10.5455/annalsmedres.2019.07.371.

El-Menyar A, Goyal P, Tilley E, Latifi R. The clinical utility of shock index to predict the need for blood transfusion and outcomes in trauma. Journal of Surgical Research. 2018 Jul; 227: 52-9. doi: 10.1016/j.jss.2018.02.013.

Luo J, Chen D, Tang L, Deng H, Zhang C, Chen S et al. Multifactorial shock: a neglected situation in polytrauma patients. Journal of Clinical Medicine. 2022 Nov; 11(22): 6829. doi: 10.3390/jcm11226829.

Richards JE, Scalea TM, Mazzeffi MA, Rock P, Galvagno Jr SM. Does lactate affect the association of early hyperglycemia and multiple organ failure in severely injured blunt trauma patients?. Anesthesia & Analgesia. 2018 Mar; 126(3): 904-10. doi: 10.1213/ANE.0000000000002626.

Indurkar Sr SK, Ghormade PS, Akhade S, Sarma B. Use of the Trauma and Injury Severity Score (TRISS) as a predictor of patient outcome in cases of trauma presenting in the trauma and emergency department of a tertiary care institute. Cureus. 2023 Jun; 15(6). doi: 10.7759/cureus.40410.

Régnier MA, Raux M, Le Manach Y, Asencio Y, Gaillard J, Devilliers C et al. Prognostic significance of blood lactate and lactate clearance in trauma patients. The Journal of the American Society of Anesthesiologists. 2012 Dec; 117(6): 1276-88. doi: 10.1097/ALN.0b013e318273349d.

Mamtani M, Kulkarni H, Bihari S, Prakash S, Chavan S, Huckson S et al. Degree of hyperglycemia independently associates with hospital mortality and length of stay in critically ill, nondiabetic patients: results from the ANZICS CORE binational registry. Journal of Critical Care. 2020 Feb; 55: 149-56. doi: 10.1016/j.jcrc.2019.11.003.