Predictive ability of combination admission lactate and base deficit in blunt trauma patients

Introduction: Elevated lactate levels are associated with increased mortality in both trauma and non-trauma patients.1-3 The relation between base deficit (BD) and mortality is less clear. Traumatologists debate the utility of elevated lactate (EL) versus BD in predicting mortality. We hypothesized that EL (2 5mmol/L) and BD ((≤-2mmol/l) in combination could predict mortality in blunt trauma patients. Methods: This is a retrospective analysis of the trauma registry from 2012-2021 at a level 1 trauma center. Blunt trauma patients with admission lactate and BD values were included in the analysis; exclusion criteria were age < 18, penetrating trauma, unknown mortality, and unknown lactate or base deficit. Logistics regression showed 93% of the patients presenting with lactate levels < 5 mmol/L, and patients with lactate > 5 mmol/L were excluded. Primary outcome was mortality. Results: 4794 patients (151 non-survivors) were included in the analysis. Non-survivors had higher rates of EL + BD (35.8% vs. 14.4%, p 65 (5.17), ISS > 25 (8.87), GCS < 8 (8.51), SBP < 90 (4.2), and ICU admission (2.61) were significant predictors of mortality. Other than GCS < 8 and ISS > 25, EL + BD had the highest odds of predicting mortality. Conclusions: ISS is a strong predictor of mortality but is not available at the time of admission. EL + BD on admission in combination represents a 5.6 fold increase in mortality in blunt trauma patients and can be used to predict patient’s outcome on admission.