Role of Venous Lactate in Predicting Outcomes in Patients with Acute Upper Gastro-Intestinal Bleeding

Abstract

Background: Several risk scores were clinically assessed for risk stratification of patients with UGIB including Glascow–Blatchford score (GBS) and Rockall score pre and post endoscopy. Many studies tried to detect value of lactate as a predictor of mortality but its role in association with other systems is not well defined. Objective: To deduct the role of lactate and other scoring systems in assessment of outcomes of UGIB. Patients and Methods: We conducted a prospective cohort study of patients admitted to ICU of Tropical Medicine Department, Zagazig University Hospitals through the period from December 2019 to March 2020 with a charted diagnosis of upper gastrointestinal bleeding (UGIB). Results: Regarding performance of GBS, Rockall score and lactate among the studied group, cutoff point of GBS was equal or less than 10.5 can be used as a predictor for recovery with sensitivity of 63.6%, specificity 100%. Cut off of Pre Rockall score was less than or equal to 4.5 can be used as a predictor for recovery with sensitivity of 60.6%, specificity of 80%. As regards venous lactate, cutoff point was equal to or less than 1.85 can be used as a predictor for recovery with sensitivity of 75.8% and specificity of 100%. Regarding lactate clearance, the cutoff point of equal to or more than 18.8% can be used as a predictor for active bleeding with sensitivity of 63.2% and specificity of 42%. Conclusion: Elevated venous lactate in association with GBS, Rockall scoring systems were found as independent predictor factors for ICU admission, transfusion, endoscopy, length of hospital stay and mortality in patients with acute UGIB.