Elevated Venous Lactate on Presentation Predicts Intensive Care Unit Admissions, Endoscopies, Transfusions and Use of Medical Therapy in Patients With Acute Gastrointestinal Bleeding

Abstract

Table: Table. Study population characteristics at initial presentation, including demographics, and history variables (univariate analysis)Table: Table. Study population characteristics at initial presentation, including clinical features, lab values, time of presentation and outcome variables (univariate analysis)Introduction: Initial clinical management decision in patients presenting to emergency department (ED) with acute gastrointestinal bleeding (GIB) is often based on identifying high- and low-risk patients. We intended to assess if venous lactate on presentation is predictive of need for intervention in patients with acute GIB. Methods: We performed a single-center, retrospective cross-sectional study including patients ≥18 years old presenting to emergency with acute GIB between January through December of 2014. Intensive care unit (ICU) admission, initiation of medical therapy (proton pump inhibitor &/or octreotide), inpatient endoscopy (upper endoscopy &/or colonoscopy) and packed red blood cell (PRBC) transfusion were assessed as outcomes. Analysis included univariate and multivariate logistic regression analysis.Figure: Area under the receiver operating characteristic (ROC) of predictive model for inpatient endoscopy.Results: Of 1,237 patients with acute GIB, 468 (37.8%) had venous lactate on presentation. Of these, 165 (35.2%) had an elevated lactate level (>2.0 mmol/L). Patients with elevated lactate were more likely to be admitted to ICU than patients with normal lactate (Adjusted Odds ratio, AOR 3.05, 95% CI 1.73-5.37; p < 0.001). Patients with elevated lactate were more likely to be started on medical therapy (AOR 2.38, 95% CI 1.12-5.11; p=0.02), receive PRBC transfusion (AOR 3.95, 95% CI 1.76-8.88; p=0.001) and endoscopy (AOR 1.70, 95% CI 1.02-2.84; p=0.04) than patients with normal lactate. Conclusion: Elevated venous lactate on presentation predicts the need for ICU admissions, medical therapy, transfusions and endoscopies in patients with acute GIB. Further prospective studies are needed to validate these findings.