Lactate Level in Critical Patients With Upper GI Bleeding
Lactate Level in Critical Patients With Upper GI Bleeding
Background: The predictive role of lactate in critically ill patients with acute upper gastrointestinal bleeding (UGIB) remains to be elucidated.
Objective: The primary objective of this study was to assess the value of lactate level on admission to predict in-hospital death in patients with UGIB admitted to the intensive care unit (ICU). The secondary objective was to assess whether lactate level adds predictive value to the clinical Rockall score in these patients.
Methods: This was a retrospective cohort study that included 133 patients with acute UGIB admitted to the ICU. Inclusion criteria were age > 18 years and presence of UGIB on admission to the ICU.
Results: Mean age was 55.4 years old and 64.7% were male. The most common cause of gastrointestinal bleeding was peptic ulcer disease, followed by erosive esophagitis/gastritis. The in-hospital mortality was 22.6%. Median lactate level in survivors and nonsurvivors was 2.0 (interquartile range [IQR] 1.2–4.2 mmol/L) and 8.8 (IQR 3.4–13.3 mmol/L; p < 0.01), respectively. The receiver operating characteristic (ROC) area to predict in-hospital death for clinical Rockall score and lactate level (0.82) was significantly higher than the ROC area for the clinical Rockall score alone (0.69) (p < 0.01).
Conclusions: In patients admitted to the ICU with acute UGIB, lactate level on admission has a high sensitivity but low specificity for predicting in-hospital death. Lactate level adds to the predictive value of the clinical Rockall score. Given its high sensitivity, lactate level can be used in addition to other prediction tools to predict outcomes in patients with UGIB.
Acute upper gastrointestinal bleeding (UGIB) accounts for >400,000 hospitalizations per year in the United States, with an estimated mortality rate ranging between 6% and 10%. In the intensive care unit (ICU), the mortality rate can be even higher. Risk stratification in UGIB is important in order to select low-risk patients for early discharge and high-risk patients for ICU management. Several scoring systems have been developed to predict outcomes after UGIB, but none of these scoring systems used serum lactate level as a predictor of outcomes. Although it is well known that in severe sepsis a high serum lactate level is associated with mortality independent of organ dysfunction and shock, the knowledge about the role of serum lactate level upon admission in predicting outcomes in patients with UGIB is still evolving. We hypothesized that the use of serum lactate level upon admission can be a valuable tool for the prediction of outcomes in patients with upper gastrointestinal hemorrhage. The primary aim of this study was to evaluate the value of the admission lactate level to predict in-hospital death in patients with UGIB admitted to the ICU. The secondary aim was to evaluate whether lactate level adds predictive value to the clinical Rockall score in these patients.
Abstract and Introduction
Abstract
Background: The predictive role of lactate in critically ill patients with acute upper gastrointestinal bleeding (UGIB) remains to be elucidated.
Objective: The primary objective of this study was to assess the value of lactate level on admission to predict in-hospital death in patients with UGIB admitted to the intensive care unit (ICU). The secondary objective was to assess whether lactate level adds predictive value to the clinical Rockall score in these patients.
Methods: This was a retrospective cohort study that included 133 patients with acute UGIB admitted to the ICU. Inclusion criteria were age > 18 years and presence of UGIB on admission to the ICU.
Results: Mean age was 55.4 years old and 64.7% were male. The most common cause of gastrointestinal bleeding was peptic ulcer disease, followed by erosive esophagitis/gastritis. The in-hospital mortality was 22.6%. Median lactate level in survivors and nonsurvivors was 2.0 (interquartile range [IQR] 1.2–4.2 mmol/L) and 8.8 (IQR 3.4–13.3 mmol/L; p < 0.01), respectively. The receiver operating characteristic (ROC) area to predict in-hospital death for clinical Rockall score and lactate level (0.82) was significantly higher than the ROC area for the clinical Rockall score alone (0.69) (p < 0.01).
Conclusions: In patients admitted to the ICU with acute UGIB, lactate level on admission has a high sensitivity but low specificity for predicting in-hospital death. Lactate level adds to the predictive value of the clinical Rockall score. Given its high sensitivity, lactate level can be used in addition to other prediction tools to predict outcomes in patients with UGIB.
Introduction
Acute upper gastrointestinal bleeding (UGIB) accounts for >400,000 hospitalizations per year in the United States, with an estimated mortality rate ranging between 6% and 10%. In the intensive care unit (ICU), the mortality rate can be even higher. Risk stratification in UGIB is important in order to select low-risk patients for early discharge and high-risk patients for ICU management. Several scoring systems have been developed to predict outcomes after UGIB, but none of these scoring systems used serum lactate level as a predictor of outcomes. Although it is well known that in severe sepsis a high serum lactate level is associated with mortality independent of organ dysfunction and shock, the knowledge about the role of serum lactate level upon admission in predicting outcomes in patients with UGIB is still evolving. We hypothesized that the use of serum lactate level upon admission can be a valuable tool for the prediction of outcomes in patients with upper gastrointestinal hemorrhage. The primary aim of this study was to evaluate the value of the admission lactate level to predict in-hospital death in patients with UGIB admitted to the ICU. The secondary aim was to evaluate whether lactate level adds predictive value to the clinical Rockall score in these patients.
