Prognostic value of lactate in prehospital care as a predictor of mortality and high-risk patients with trauma

Objectives. Major injury is a time-depend-ent illness in which the quantification of the life prognosis is fundamental for pro-fessionals. The objective of this study is to evaluate the capacity of prehospital lactic acid to predict mortality (2, 7 and 30 days) and the admission to the Intensive Care Unit (ICU) from the index event. Methods. This is a longitudinal, prospec-tive observational study, which included patients who were treated by an Advanced Life Support Unit and transferred to the Emergency Department between April 1 and September 30, 2018. We calculated sensitivity, specificity, and likelihood ra-tios. The main outcome variable was mor-tality from any cause (2, 7 and 30 days) and admission to ICU.

Results. 109 patients were included in our study. Eleven patients (10%) experienced early mortality before the first 48 hours af-ter the index event, with an ICU admission rate of 28%. The sensitivity and specificity of the test to determine mortality in less than two days was 63.6% (95% CI, 35.4-84.8%) and 87.8% (95% CI, 79.8-92.9%). Conclusions. Prehospital lactic acid has an excellent capacity to predict the mortality and the admission of patients with major injury to the ICU, and it is a cheap, easy-to-obtain and reliable diagnostic tool that can help in clinical decision-making.

Critical care; emergency depart-ment; outcome; survival; intensive care

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