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. 2023 Apr 5;12(7):2716.
doi: 10.3390/jcm12072716.

Comparison of Lactate Clearance with Established Risk Assessment Tools in Predicting Outcomes in Acute Upper Gastrointestinal Bleeding

Gabriel Allo  1 , Johannes Gillessen  1 , Dilan Gülcicegi  1 , Philipp Kasper  1 , Seung-Hun Chon  2 , Tobias Goeser  1 , Martin Bürger  1
Affiliations

Comparison of Lactate Clearance with Established Risk Assessment Tools in Predicting Outcomes in Acute Upper Gastrointestinal Bleeding

Gabriel Allo et al. J Clin Med. .

Abstract

Early risk stratification is mandatory in acute upper gastrointestinal bleeding (AUGIB) to guide optimal treatment. Numerous risk scores were introduced, but lack of practicability led to limited use in daily clinical practice. Lactate clearance is an established risk assessment tool in a variety of diseases, such as trauma and sepsis. Therefore, this study compares the predictive ability of pre-endoscopic lactate clearance and established risk scores in patients with AUGIB at the University Hospital of Cologne. Active bleeding was detected in 27 (25.2%) patients, and hemostatic intervention was performed in 35 (32.7%). In total, 16 patients (15%) experienced rebleeding and 12 (11.2%) died. Initially, lactate levels were elevated in 64 cases (59.8%), and the median lactate clearance was 18.7% (2.7-48.2%). Regarding the need for endoscopic intervention, the predictive ability of Glasgow Blatchford Score, pre-endoscopic Rockall score, initial lactate and lactate clearance did not differ significantly, and their area under the receiver operating characteristic curves were 0.658 (0.560-0.747), 0.572 (0.473-0.667), 0.572 (0.473-0.667) and 0.583 (0.483-0.677), respectively. Similar results were observed in relation to rebleeding and mortality. In conclusion, lactate clearance had comparable predictive ability compared to established risk scores. Further prospective research is necessary to clarify the potential role of lactate clearance as a reliable risk assessment tool in AUGIB.

Keywords: emergency medicine; endoscopy; gastrointestinal bleeding.

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Conflict of interest statement

Martin Bürger obtained consulting fees from Janssen and travel support from Pfizer. All other authors declare that they have no conflict of interest regarding this manuscript.

Figures

Figure 1
Figure 1
AUROCs of risk assessment tools for the prediction of need for intervention, not applicable to full Rockall Score. GBS, Glasgow–Blatchford score; iL, initial lactate; LC, lactate clearance; p-RS, pre-endoscopic RS.
Figure 2
Figure 2
AUROCs of risk assessment tools for the prediction of 30-day mortality fRS, full Rockall score; GBS, Glasgow–Blatchford score; iL, initial lactate; LC, lactate clearance; p-RS, pre-endoscopic RS.
Figure 3
Figure 3
AUROCs of risk assessment tools for the prediction of and rebleeding fRS, full Rockall score; GBS, Glasgow–Blatchford score; iL, initial lactate; LC, lactate clearance; p-RS, pre-endoscopic RS.
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