Lactate, lactate clearance, and lactate-to-albumin ratio in predicting mortality in patients with critical polytrauma: A retrospective observational study

Abstract

Lactate is a product of anaerobic metabolism used to determine prognosis in critically ill trauma patients. This study investigates the mortality-predictive performance of lactate, lactate clearance, and lactate-to-albumin ratio (LAR) on admission in patients with polytrauma in a tertiary center's intensive care unit (ICU). Polytrauma patients in the ICU between June 2019 and June 2022 were evaluated. The diagnosis of polytrauma was made according to the Berlin criteria, a widely accepted and comprehensive system for classifying the severity of multiple injuries. Patients were classified into survivor and mortality groups. The predictive performance of lactate, lactate clearance (24th hour), and LAR for 28-day mortality was compared. The study included 176 patients. The median age of the entire population was 35 (24-50) years, and 78.4% (n = 138) were male. Motor vehicle accidents were the most common cause of polytrauma in patients (48.9%, n = 86). The most common head injuries were detected in the patients (59.1%, n = 104). In the mortality group, median lactate and lactate (24th hour) levels were significantly higher (P < .001). Median albumin and LAR values were significantly lower (P < .001). Although 24-hour lactate clearance was lower in the mortality group, no significant difference was detected (36.1% vs 42.3%, P = .052). In multivariate regression analysis, LAR was an independent predictor of mortality (P < .001). In receiver operating characteristics curve analysis, the cutoff value of lactate was ≥5.4, the area under the curve (AUC) was 0.75 (95% confidence interval [CI], 0.66-0.84), the cutoff value of lactate clearance was ≤39.2, AUC was 0.60, (95% CI, 0.51-0.69), and the cutoff value of LAR was value ≥1.50, AUC 0.83 (95% CI, 0.75-0.90). In critically ill polytrauma patients, LAR on ICU admission is an independent predictor of mortality and has acceptable prognostic value. LAR is superior to lactate and 24-hour lactate clearance in predicting mortality.

Figure 1.

Flow chart of the study.