Early lactate clearance for predicting outcomes in patients with gastrointestinal bleeding.

Abstract

Acute gastrointestinal bleeding (GI bleeding) can range from mild symptoms to life-threatening conditions that require emergency intervention. Therefore, it is important to first identify the high-risk and low-risk patients in the emergency department (ED). This study aimed to investigate the usefulness of a three-hourly interval for determining the lactate clearance, which is shorter than the time interval in previous studies, in order to predict the prognosis early in patients with GI bleeding. This retrospective study involved patients who visited for complaining of GI bleeding symptoms. Initial lactate levels were measured upon arrival at the ED and measured again 3h later after performing initial resuscitation. And 3-h lactate clearance was calculated. Lactate and 3-h lactate clearance for predicting outcomes were evaluated by the area under the receiver operating characteristic (AUROC) curve. A total of 104 patients were enrolled and 21 patients (20.2%) died in the hospital. Multivariate logistic regression showed that 3-h lactate clearance was a significant predictor of in-hospital mortality. The AUROC of 3-h lactate clearance for predicting in-hospital mortality was 0.756. The sensitivity and specificity were 66.67% and 75.90%. On combining lactate clearance, total bilirubin, and PTT, the AUROC was 0.899 for predicting in-hospital mortality. This study validated that lactate clearance at three-hourly intervals is useful for early prediction of mortality and prognosis in patients with GI bleeding. It is important to perform not only an initial lactate measurement, but also a follow-up lactate measurement after initial resuscitation to check the lactate clearance.