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The association between the initial lactate level and need for massive transfusion in severe trauma patients with and without traumatic brain injury

机译：初始乳酸水平之间的关联，需要在没有创伤性脑损伤的严重创伤患者中大规模输血

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BACKGROUND:Exsanguination is a major cause of death in severe trauma patients. The purpose of this study was to analyze the prognostic impact of the initial lactate level for massive transfusion (MT) in severe trauma. We divided patients according to subgroups of traumatic brain injury (TBI) and non-TBI.METHODS:This single-institution retrospective study was conducted on patients who were admitted to hospital for severe trauma between January 2016 and December 2017. TBI was defined by a head Abbreviated Injury Scale ≥3. Receiver operating characteristic analysis was used to analyze the prognostic impact of the lactate level. Multivariate analyses were performed to evaluate the relationship between the MT and lactate level. The primary outcome was MT.RESULTS:Of the 553 patients, MT was performed in 62 patients (11.2%). The area under the curve (AUC) for the lactate level for predicting MT was 0.779 (95% confidence interval [CI], 0.742 to 0.813). The AUCs for lactate level in the TBI and non-TBI patients were 0.690 (95% CI, 0.627 to 0.747) and 0.842 (95% CI, 0.796 to 0.881), respectively. In multivariate analyses, the lactate level was independently associated with the MT (odds ratio [OR], 1.179; 95% CI, 1.070 to 1.299). The lactate level was independently associated with MT in non-TBI patients (OR, 1.469; 95% CI, 1.262 to 1.710), but not in TBI patients.CONCLUSIONS:The initial lactate level may be a possible prognostic factor for MT in severe trauma. In TBI patients, however, the initial lactate level was not suitable for predicting MT.
机译：背景：放血是严重创伤患者死亡的主要原因。本研究的目的是分析初始乳酸水平在严重创伤中的初始输血（MT）的预后撞击。根据创伤性脑损伤（TBI）和非TBI的亚组分为患者。方法：这项单一机构回顾性研究是对2016年1月至2017年1月至2017年12月的严重创伤的患者患者进行的。TBI被A定义头部缩写损伤量表≥3。接收器操作特征分析用于分析乳酸水平的预后影响。进行多变量分析以评估Mt和乳酸水平之间的关系。主要结果是mt.results：553例患者，在62名患者中进行MT（11.2％）。用于预测MT的乳酸水平的曲线（AUC）下的区域为0.779（95％置信区间[CI]，0.742至0.813）。 TBI和非TBI患者乳酸水平的AUC分别为0.690（95％CI，0.627至0.747）和0.842（95％CI，0.796至0.881）。在多变量分析中，乳酸水平与Mt（差距率[或]，1.179; 95％CI，1.070至1.299）独立相关。乳酸水平与非TBI患者的MT独立相关（或1.469; 95％CI，1.262至1.710），但不是在TBI患者中。结论：初始乳酸水平可能是严重创伤中MT的可能预后因素。然而，在TBI患者中，初始乳酸水平不适合预测MT。

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