Arterial lactate does not predict outcome better than existing risk scores in upper gastrointestinal bleeding

Research output: Contribution to journalJournal articleResearchpeer-review

Abstract

OBJECTIVE: Upper gastrointestinal bleeding (UGIB) is a frequent medical emergency and several scoring systems are developed to help risk-stratify patients. We aimed to investigate if elevated arterial lactate (AL) was associated with 30-day mortality, need for hospital-based intervention, or rebleeding. Furthermore, we compared the performance of AL with existing scoring systems and examined if incorporation of AL could improve their predictive ability.

MATERIALS AND METHODS: Retrospective cohort study of 331 consecutive patients admitted with UGIB during a one-year period. Multivariate analyses were performed to evaluate the association between AL and outcomes. Receiver operating characteristic curves were used to compare AL with existing scoring systems and to test if incorporation of AL could significantly increase their performance.

RESULTS: AL was significantly associated with mortality (p = .001), need for hospital-based intervention (p = .005), and rebleeding (p = .031). In predicting mortality and rebleeding, AL performed equally to existing scoring systems, however, inferior to all, in predicting need for intervention. Two of the scoring systems were marginally improved in predicting mortality if AL was included.

CONCLUSIONS: AL is associated with adverse outcomes in patients with UGIB, but has only similar or inferior ability to predict relevant clinical outcomes compared to existing scoring systems. Although AL could enhance performance of two scorings systems in predicting mortality, it does not have an apparent clinical significance. Thus, our data does not support routine measurement of AL in patients with UGIB.

Original languageEnglish
JournalScandinavian Journal of Gastroenterology
Volume53
Issue number5
Pages (from-to)586-591
ISSN0036-5521
DOIs
Publication statusPublished - May 2018

Keywords

  • Adult
  • Aged
  • Aged, 80 and over
  • Biomarkers/blood
  • Blood Transfusion
  • Denmark/epidemiology
  • Female
  • Gastrointestinal Hemorrhage/mortality
  • Hospitals, University
  • Humans
  • Lactic Acid/blood
  • Logistic Models
  • Male
  • Middle Aged
  • Multivariate Analysis
  • Predictive Value of Tests
  • ROC Curve
  • Recurrence
  • Retrospective Studies
  • Risk Assessment/methods
  • Severity of Illness Index

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