Araştırma Makalesi
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Künt çoklu travmalı hastalarda mortalite belirleyicisi olarak laboratuvar parametrelerinin araştırılması

Yıl 2024, Cilt: 17 Sayı: 3, 468 - 475, 05.07.2024
https://doi.org/10.31362/patd.1435793

Öz

Amaç: Travma hastalarında vital bulgular hasta yönetiminde yeterli olmayabilir. Bu nedenle travma hastalarının yönetiminde yaşamsal bulguların, bazı laboratuvar parametrelerinin ve görüntüleme yöntemlerinin değerlendirilmesi esastır. Künt multi-travma hastalarının değerlendirilmesinde laktat ve baz fazlalığının (BE) morbidite ve mortalitenin erken bir belirteci olduğu hipotezinden yola çıkarak, künt multi-travma hastalarında mortaliteyi öngörmede laktat ve BE'ye ek olarak laktat albümin oranı ve laktat dehidrogenaz (LDH) albümin oranının değerini araştırmayı amaçladık.
Gereç ve yöntem: Bu tek merkezli, retrospektif bir çalışmadır. Veri toplanmadan önce yerel etik kuruldan onay alınmıştır. Çalışmaya, 1 Ocak 2018 ile 31 Aralık 2021 tarihleri arasında Türkiye'deki üçüncü basamak bir eğitim ve araştırma hastanesinin acil servisine çoklu travma ile başvuran ve dışlama kriterlerini karşılamayan hastalar dahil edildi. Bu çalışmada, künt çoklu travma hastalarında, mortaliteyi öngörmede Laktat, BE, Laktat / albümin oranı ve LDH / albümin oranının tanısal değerliliği hesaplanmıştır.
Bulgular: Mortalite için laktat kesme değeri 4,2 olup %73,3 duyarlılık ve %89,2 özgüllük sergilemektedir. Mortalite için BE kesme değeri -3 olup %80,0 duyarlılık ve %76,9 özgüllük sergilemektedir. Mortalite için laktat albümin oranı kesme değeri 0,11 olup %73,3 duyarlılık ve %90,8 özgüllük sergilemektedir. Mortalite için LDH albümin oranı kesme değeri 7,2 olup %86,7 duyarlılık ve %58,5 özgüllük sergilemektedir.
Sonuç: Laktat albümin oranı mortaliteyi öngörmede laktat ve BE'ye göre daha spesifik iken, LDH albümin oranı mortaliteyi öngörmede laktat ve BE'ye göre daha duyarlıydı.

Kaynakça

  • 1. Tintinalli JE, Ma OJ, Yealy D, et al. Tintinalli's Emergency Medicine: A Comprehensive Study Guide. 9th Edition. New York: 2019.
  • 2. Kirkpatrick AW, Ball CG, D'Amours SK, Zygun D. Acute resuscitation of the unstable adult trauma patient: bedside diagnosis and therapy. Can J Surg 2008;51:57-69.
  • 3. American College of Surgeons, Committee on Trauma: Advanced Trauma Life Support for Doctors, Student Course Manual. 10th Edition. Chicago: 2018.
  • 4. Yazıcı MM, Yavaşi O, Çelik A, et al. The role of repeated extended FAST in patients with stable blunt thoracoabdominal trauma. Ulus Travma Acil Cerrahi Derg 2023;29:553-559. https://doi.org/10.14744/tjtes.2022.93529
  • 5. Kuas C, Acar N, Ozakin E, et al. The diagnostic value of laboratory tests in detecting solid organ injuries in pediatric patients with blunt abdominal trauma. Am J Emerg Med 2022;57:133-137. https://doi.org/10.1016/j.ajem.2022.04.039
  • 6. Raux M, Le Manach Y, Gauss T, et al. Comparison of the Prognostic Significance of Initial Blood Lactate and Base Deficit in Trauma Patients. Anesthesiology 2017;126:522-533. https://doi.org/10.1097/ALN.0000000000001490
  • 7. Ibrahim I, Chor WP, Chue KM, Tan CS, Tan HL, Siddiqui FJ, et al. Is arterial base deficit still a useful prognostic marker in trauma? A systematic review. Am J Emerg Med 2016;34:626-635. https://doi.org/10.1016/j.ajem.2015.12.012
  • 8. Callaway DW, Shapiro NI, Donnino MW, Baker C, Rosen CL. Serum lactate and base deficit as predictors of mortality in normotensive elderly blunt trauma patients. J Trauma 2009;66:1040-1044. https://doi.org/10.1097/TA.0b013e3181895e9e
  • 9. Abt R, Lustenberger T, Stover JF, et al. Base excess determined within one hour of admission predicts mortality in patients with severe pelvic fractures and severe hemorrhagic shock. Eur J Trauma Emerg Surg 2009;35:429-436. https://doi.org/10.1007/s00068-009-8245-7
  • 10. Baxter J, Cranfield KR, Clark G, Harris T, Bloom B, Gray AJ. Do lactate levels in the emergency department predict outcome in adult trauma patients? A systematic review. J Trauma Acute Care Surg 2016;81:555-566. https://doi.org/10.1097/TA.0000000000001156
  • 11. Altuntaş G, Yazıcı MM, Çelik A, Yavaşi Ö. The prognostic significance of lactate dehydrogenase albumin ratio in elderly COVID-19 patients. Mid Blac Sea J Health Sci 2022;8:432-439. https://doi.org/10.19127/mbsjohs.1129139
  • 12. Wang G, Liu J, Xu R, Fu Y, Liu X. Lactate/albumin ratio as a predictor of in-hospital mortality in critically ill children. BMC Pediatr 2022;22:725(e1-11). https://doi.org/10.1186/s12887-022-03787-0
  • 13. Ray CC, Pollack MM, Gai J, Patel AK. The association of the lactate-albumin ratio with mortality and multiple organ dysfunction in PICU patients. Pediatr Crit Care Med 2023;24:760-766. https://doi.org/10.1097/PCC.0000000000003272
  • 14. Javali RH, Ravindra P, Patil A, et al. A clinical study on the ınitial assessment of arterial lactate and base deficit as predictors of outcome in trauma patients. Indian J Crit Care Med 2017;21:719-725. https://doi.org/10.4103/ijccm.IJCCM_218_17
  • 15. Qi J, Bao L, Yang P, Chen D. Comparison of base excess, lactate and pH predicting 72-h mortality of multiple trauma. BMC Emerg Med 2021;21:80(e1-7). https://doi.org/10.1186/s12873-021-00465-9
  • 16. Jyoti D, Kumar A, Halim T, Hai AA. The association between serum lactate concentration, base deficit, and mortality in polytrauma patients as a prognostic factor: an observational study. Cureus 2022;14:e28200. https://doi.org/10.7759/cureus.28200
  • 17. Wang R, He M, Qu F, Zhang J, Xu J. Lactate albumin ratio is associated with mortality in patients with moderate to severe traumatic brain injury. Front Neurol 2022;13:662385(e1-9). https://doi.org/10.3389/fneur.2022.662385
  • 18. Aday U, Böyük A, Akkoç H. The prognostic significance of serum lactate dehydrogenase-to-albumin ratio in colorectal cancer. Ann Surg Treat Res 2020;99:161-170. https://doi.org/10.4174/astr.2020.99.3.161
  • 19. Jeon SY, Ryu S, Oh SK, et al. Lactate dehydrogenase to albumin ratio as a prognostic factor for patients with severe infection requiring intensive care. Medicine (Baltimore) 2021;100:e27538(e1-7). https://doi.org/10.1097/MD.0000000000027538
  • 20. Lee BK, Ryu S, Oh SK, et al. Lactate dehydrogenase to albumin ratio as a prognostic factor in lower respiratory tract infection patients. Am J Emerg Med 2022;52:54-58. https://doi.org/10.1016/j.ajem.2021.11.028

Investigation of laboratory parameters as mortality marker in patients with blunt multi-trauma

Yıl 2024, Cilt: 17 Sayı: 3, 468 - 475, 05.07.2024
https://doi.org/10.31362/patd.1435793

Öz

Purpose: In trauma patients, vital signs may not be beneficial in patient management. Therefore, evaluating vital signs, some laboratory parameters, and imaging methods is essential in managing trauma patients. Based on the hypothesis that lactate and base excess (BE) is an early marker of morbidity and mortality in the evaluation in blunt multi-trauma patients, we aimed to investigate the value of lactate albumin ratio and lactate dehydrogenase (LDH) albumin ratio in addition to lactate and BE in predicting mortality in blunt multi-trauma patients.
Materials and methods: This was a single-centre, retrospective study. Prior to data collection, approval was obtained from the local ethics committee. Patients admitted with multi-trauma to the emergency department of a tertiary education and research hospital in Türkiye between January 1, 2018, and December 31, 2021, who did not meet the exclusion criteria, were included in the study. This study examined the predictive value of Lactate, BE, Lactate-to-albumin ratio, and LDH-to-albumin ratio in predicting mortality in blunt multi-trauma patients.
Results: The lactate cut-off value for mortality was 4.2, exhibiting 73.3% sensitivity and 89.2% specificity. The BE cut-off value for mortality was -3, exhibiting 80.0% sensitivity and 76.9% specificity. The lactate-albumin ratio cut-off value for mortality was 0.11, exhibiting 73.3% sensitivity and 90.8% specificity. The LDH-albumin ratio cut-off value for mortality was 7.2, exhibiting 86.7% sensitivity and 58.5% specificity.
Conclusion: Lactate albumin ratio was more specific in predicting mortality than lactate and BE, while LDH albumin ratio was more sensitive in predicting mortality than lactate and BE.

Etik Beyan

This study was approved by the institutional review board and ethics committee (Number: E-40465587-050.01.04-955 and ID: 2024/29).

Destekleyen Kurum

None declared.

Teşekkür

We would like to express a special thank to Emergency Department of Recep Tayyip Erdoğan University Training and Research Hospital.

Kaynakça

  • 1. Tintinalli JE, Ma OJ, Yealy D, et al. Tintinalli's Emergency Medicine: A Comprehensive Study Guide. 9th Edition. New York: 2019.
  • 2. Kirkpatrick AW, Ball CG, D'Amours SK, Zygun D. Acute resuscitation of the unstable adult trauma patient: bedside diagnosis and therapy. Can J Surg 2008;51:57-69.
  • 3. American College of Surgeons, Committee on Trauma: Advanced Trauma Life Support for Doctors, Student Course Manual. 10th Edition. Chicago: 2018.
  • 4. Yazıcı MM, Yavaşi O, Çelik A, et al. The role of repeated extended FAST in patients with stable blunt thoracoabdominal trauma. Ulus Travma Acil Cerrahi Derg 2023;29:553-559. https://doi.org/10.14744/tjtes.2022.93529
  • 5. Kuas C, Acar N, Ozakin E, et al. The diagnostic value of laboratory tests in detecting solid organ injuries in pediatric patients with blunt abdominal trauma. Am J Emerg Med 2022;57:133-137. https://doi.org/10.1016/j.ajem.2022.04.039
  • 6. Raux M, Le Manach Y, Gauss T, et al. Comparison of the Prognostic Significance of Initial Blood Lactate and Base Deficit in Trauma Patients. Anesthesiology 2017;126:522-533. https://doi.org/10.1097/ALN.0000000000001490
  • 7. Ibrahim I, Chor WP, Chue KM, Tan CS, Tan HL, Siddiqui FJ, et al. Is arterial base deficit still a useful prognostic marker in trauma? A systematic review. Am J Emerg Med 2016;34:626-635. https://doi.org/10.1016/j.ajem.2015.12.012
  • 8. Callaway DW, Shapiro NI, Donnino MW, Baker C, Rosen CL. Serum lactate and base deficit as predictors of mortality in normotensive elderly blunt trauma patients. J Trauma 2009;66:1040-1044. https://doi.org/10.1097/TA.0b013e3181895e9e
  • 9. Abt R, Lustenberger T, Stover JF, et al. Base excess determined within one hour of admission predicts mortality in patients with severe pelvic fractures and severe hemorrhagic shock. Eur J Trauma Emerg Surg 2009;35:429-436. https://doi.org/10.1007/s00068-009-8245-7
  • 10. Baxter J, Cranfield KR, Clark G, Harris T, Bloom B, Gray AJ. Do lactate levels in the emergency department predict outcome in adult trauma patients? A systematic review. J Trauma Acute Care Surg 2016;81:555-566. https://doi.org/10.1097/TA.0000000000001156
  • 11. Altuntaş G, Yazıcı MM, Çelik A, Yavaşi Ö. The prognostic significance of lactate dehydrogenase albumin ratio in elderly COVID-19 patients. Mid Blac Sea J Health Sci 2022;8:432-439. https://doi.org/10.19127/mbsjohs.1129139
  • 12. Wang G, Liu J, Xu R, Fu Y, Liu X. Lactate/albumin ratio as a predictor of in-hospital mortality in critically ill children. BMC Pediatr 2022;22:725(e1-11). https://doi.org/10.1186/s12887-022-03787-0
  • 13. Ray CC, Pollack MM, Gai J, Patel AK. The association of the lactate-albumin ratio with mortality and multiple organ dysfunction in PICU patients. Pediatr Crit Care Med 2023;24:760-766. https://doi.org/10.1097/PCC.0000000000003272
  • 14. Javali RH, Ravindra P, Patil A, et al. A clinical study on the ınitial assessment of arterial lactate and base deficit as predictors of outcome in trauma patients. Indian J Crit Care Med 2017;21:719-725. https://doi.org/10.4103/ijccm.IJCCM_218_17
  • 15. Qi J, Bao L, Yang P, Chen D. Comparison of base excess, lactate and pH predicting 72-h mortality of multiple trauma. BMC Emerg Med 2021;21:80(e1-7). https://doi.org/10.1186/s12873-021-00465-9
  • 16. Jyoti D, Kumar A, Halim T, Hai AA. The association between serum lactate concentration, base deficit, and mortality in polytrauma patients as a prognostic factor: an observational study. Cureus 2022;14:e28200. https://doi.org/10.7759/cureus.28200
  • 17. Wang R, He M, Qu F, Zhang J, Xu J. Lactate albumin ratio is associated with mortality in patients with moderate to severe traumatic brain injury. Front Neurol 2022;13:662385(e1-9). https://doi.org/10.3389/fneur.2022.662385
  • 18. Aday U, Böyük A, Akkoç H. The prognostic significance of serum lactate dehydrogenase-to-albumin ratio in colorectal cancer. Ann Surg Treat Res 2020;99:161-170. https://doi.org/10.4174/astr.2020.99.3.161
  • 19. Jeon SY, Ryu S, Oh SK, et al. Lactate dehydrogenase to albumin ratio as a prognostic factor for patients with severe infection requiring intensive care. Medicine (Baltimore) 2021;100:e27538(e1-7). https://doi.org/10.1097/MD.0000000000027538
  • 20. Lee BK, Ryu S, Oh SK, et al. Lactate dehydrogenase to albumin ratio as a prognostic factor in lower respiratory tract infection patients. Am J Emerg Med 2022;52:54-58. https://doi.org/10.1016/j.ajem.2021.11.028
Toplam 20 adet kaynakça vardır.

Ayrıntılar

Birincil Dil İngilizce
Konular Acil Tıp, Ortopedi
Bölüm Araştırma Makalesi
Yazarlar

Mümin Murat Yazıcı 0000-0003-1957-7283

Nurullah Parça 0009-0002-2492-3128

Utku Sarp Cerit 0009-0007-9697-3112

Özlem Bilir 0000-0001-9016-1665

Erken Görünüm Tarihi 3 Nisan 2024
Yayımlanma Tarihi 5 Temmuz 2024
Gönderilme Tarihi 12 Şubat 2024
Kabul Tarihi 15 Mart 2024
Yayımlandığı Sayı Yıl 2024 Cilt: 17 Sayı: 3

Kaynak Göster

APA Yazıcı, M. M., Parça, N., Cerit, U. S., Bilir, Ö. (2024). Investigation of laboratory parameters as mortality marker in patients with blunt multi-trauma. Pamukkale Medical Journal, 17(3), 468-475. https://doi.org/10.31362/patd.1435793
AMA Yazıcı MM, Parça N, Cerit US, Bilir Ö. Investigation of laboratory parameters as mortality marker in patients with blunt multi-trauma. Pam Tıp Derg. Temmuz 2024;17(3):468-475. doi:10.31362/patd.1435793
Chicago Yazıcı, Mümin Murat, Nurullah Parça, Utku Sarp Cerit, ve Özlem Bilir. “Investigation of Laboratory Parameters As Mortality Marker in Patients With Blunt Multi-Trauma”. Pamukkale Medical Journal 17, sy. 3 (Temmuz 2024): 468-75. https://doi.org/10.31362/patd.1435793.
EndNote Yazıcı MM, Parça N, Cerit US, Bilir Ö (01 Temmuz 2024) Investigation of laboratory parameters as mortality marker in patients with blunt multi-trauma. Pamukkale Medical Journal 17 3 468–475.
IEEE M. M. Yazıcı, N. Parça, U. S. Cerit, ve Ö. Bilir, “Investigation of laboratory parameters as mortality marker in patients with blunt multi-trauma”, Pam Tıp Derg, c. 17, sy. 3, ss. 468–475, 2024, doi: 10.31362/patd.1435793.
ISNAD Yazıcı, Mümin Murat vd. “Investigation of Laboratory Parameters As Mortality Marker in Patients With Blunt Multi-Trauma”. Pamukkale Medical Journal 17/3 (Temmuz 2024), 468-475. https://doi.org/10.31362/patd.1435793.
JAMA Yazıcı MM, Parça N, Cerit US, Bilir Ö. Investigation of laboratory parameters as mortality marker in patients with blunt multi-trauma. Pam Tıp Derg. 2024;17:468–475.
MLA Yazıcı, Mümin Murat vd. “Investigation of Laboratory Parameters As Mortality Marker in Patients With Blunt Multi-Trauma”. Pamukkale Medical Journal, c. 17, sy. 3, 2024, ss. 468-75, doi:10.31362/patd.1435793.
Vancouver Yazıcı MM, Parça N, Cerit US, Bilir Ö. Investigation of laboratory parameters as mortality marker in patients with blunt multi-trauma. Pam Tıp Derg. 2024;17(3):468-75.
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