Venous glucose and arterial lactate as biochemical predictors of mortality in clinically severely injured trauma patients—a comparison with ISS and TRISS

Tarik Sammour, Arman Kahokehr, Stuart Caldwell, Andrew G Hill
Injury 2009, 40 (1): 104-8

BACKGROUND: Early assessment of injury severity is important in trauma. Trauma scores are calculated after the fact and are useful for audit and research, but not in the emergency clinical setting. Glucose metabolism is altered in trauma, and we hypothesised that alterations in glucose and lactate levels would be an early predictor of mortality.

METHODS: Review of trauma registry data identified 1197 patients between May 2000 and September 2006 who had a trauma-team call out. Data collected included trauma scores, venous glucose (gluc), and arterial lactate (lact) on arrival. The predictive value of these variables was compared by ROC curves.

RESULTS: The mortality rate for patients with gluc >11.0mmol/L was 13.4% compared to 1.8% in those with gluc <or=11.0mmol/L (p<0.0001). Gluc had a specificity of 93.2% and a sensitivity of 37.9% for death. 13.0% of patients with lact >2.0mmol/L died, versus 2.7% with lact <or=2.0mmol/L, (p0.0003, specificity 56.8% and sensitivity 81.0%). Glucose was the better biochemical predictor of mortality compared to lactate (ROC area 0.845 and 0.716, respectively). The TRISS (trauma and injury severity score) was a very accurate predictor (ROC 0.963), whereas the ISS (injury severity score) significantly less so (ROC 0.854). There was a significant correlation between gluc, ISS, and TRISS (p 0.01), as well as lactate and ISS (p 0.01).

CONCLUSION: Glucose and lactate can predict mortality in severe trauma. The predictive value of glucose is comparable to that of ISS, and can be more easily employed in the clinical setting.

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