Elevated lactate level predicts intensive care unit admissions, endoscopies and transfusions in patients with acute gastrointestinal bleeding
Authors Shrestha MP, Borgstrom M, Trowers EA
Received 16 January 2018
Accepted for publication 26 March 2018
Published 23 May 2018 Volume 2018:11 Pages 185—192
Checked for plagiarism Yes
Review by Single-blind
Peer reviewers approved by Dr Andrew Yee
Peer reviewer comments 2
Editor who approved publication: Dr Anastasios Koulaouzidis
Manish P Shrestha,1 Mark Borgstrom,2 Eugene Abraham Trowers3
1Department of Medicine, University of Arizona College of Medicine, Tucson, AZ, USA; 2Research Computing Group of University Information Technology Services, University of Arizona, Tucson, AZ, USA; 3Division of Gastroenterology, University of Arizona College of Medicine, Tucson, AZ, USA
Background and aims: Initial clinical management decision in patients with acute gastrointestinal bleeding (GIB) is often based on identifying high- and low-risk patients. Little is known about the role of lactate measurement in the triage of patients with acute GIB. We intended to assess if lactate on presentation is predictive of need for intervention in patients with acute GIB.
Patients and methods: We performed a single-center, retrospective, cross-sectional study including patients ≥18 years old presenting to emergency with acute GIB between January 2014 and December 2014. Intensive care unit (ICU) admission, inpatient endoscopy (upper endoscopy and/or colonoscopy), and packed red blood cell (PRBC) transfusion were assessed as outcomes. Analyses included univariate and multivariate logistic regression analyses.
Results: Of 1,237 patients with acute GIB, 468 (37.8%) had venous lactate on presentation. Of these patients, 165 (35.2%) had an elevated lactate level (>2.0 mmol/L). Patients with an elevated lactate level were more likely to be admitted to ICU than patients with a normal lactate level (adjusted odds ratio [AOR] 2.96, 95% confidence interval [CI] 1.74–5.01; p<0.001). Patients with an elevated lactate level were more likely to receive PRBC transfusion (AOR 3.65, 95% CI 1.76–7.55; p<0.001) and endoscopy (AOR 1.64, 95% CI 1.02–2.65; p=0.04) than patients with a normal lactate level.
Conclusion: Elevated lactate level predicts the need for ICU admissions, transfusions, and endoscopies in patients with acute GIB. Lactate measurement may be a useful adjunctive test in the triage of patients with acute GIB.
Keywords: venous lactate, ICU admissions, endoscopy, acute gastrointestinal bleeding
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