Measurement of blood lactate, D-dimer, and activated prothrombin time improves prediction of in-hospital mortality in adults blunt trauma

• Published in: The American journal of emergency medicine Vol. 36; no. 3; pp. 370 - 375
• Main Authors: Umebachi, Rimako, Taira, Takayuki, Wakai, Shinjiro, Aoki, Hiromichi, Otsuka, Hiroyuki, Nakagawa, Yoshihide, Inokuchi, Sadaki
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.03.2018; Elsevier Limited
• Subjects: Activated prothrombin time; Adult; Age Factors; Aged; Aged, 80 and over; Biomarkers; Blood pressure; Blunt trauma; Coma; D-dimer; Emergency medical care; Female; Fibrin Fibrinogen Degradation Products - analysis; Hospital Mortality; Humans; Intensive care; Laboratories; Lactate; Lactates - blood; Lactic acid; Male; Medical records; Metabolism; Middle Aged; Mortality; Plasma; Prediction models; Prothrombin; Prothrombin Time; Retrospective Studies; Risk Factors; Sex Factors; Trauma; Traumatic brain injury; Vital signs; Wounds, Nonpenetrating - blood; Wounds, Nonpenetrating - diagnosis; Wounds, Nonpenetrating - mortality; Japan; Activated prothrombin time; D-dimer; Blunt trauma; Lactate; Mortality
• ISSN: 0735-6757; 1532-8171
• DOI: 10.1016/j.ajem.2017.08.025

Limitations This study was a retrospective study of blunt trauma patients in a single facility: therefore, external validation using data from patients enrolled in other institutions and countries will be necessary hereafter. [...]missing data may have introduced bias, since 1533 cases with data missing from their medical records at admission for lactate or D-dimer levels or APTT were excluded from analysis. Another analysis of trauma patients aged 65years and older who were transported to a trauma center found a venous blood lactate concentration on arrival of >2.5mmol/L to be an independent risk factor for in-hospital mortality [39]. [...]an additional report found the admission blood lactate concentration of blunt trauma patients aged 65 and older with systolic blood pressure of >90mm Hg upon ED admission to be significantly higher in the subgroup of patients who experienced in-hospital mortality when compared with those who survived. Trauma patients with prolonged admission prothrombin time, APTT, or thrombin time have been found to have significantly higher mortality rates than those without prolongation of these factors [27]. [...]high early-mortality rates have been reported in trauma patients with an elevated international ratio of prothrombin or prolonged APTT on ED admission [28]. [...]the ability of a prediction model to predict in-hospital mortality in adult blunt trauma patients improved following the addition of blood lactate concentration, D-dimer concentration, and APTT measured on ED arrival as explanatory variables.