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The Comparison of Base Deficit, Lactate, and Strong Ion Gap as Early Predictor of Mortality in Trauma Patients  

Park, Kyung Hye (Department of Emergency Medicine, Wonju College of Medicine, Yonsei University)
Lee, Kang Hyun (Department of Emergency Medicine, Wonju College of Medicine, Yonsei University)
Kim, Seon Hyu (Department of Emergency Medicine, Wonju College of Medicine, Yonsei University)
Oh, Sung Bum (Department of Emergency Medicine, Wonju College of Medicine, Yonsei University)
Moon, Joong Bum (Department of Emergency Medicine, Wonju College of Medicine, Yonsei University)
Kim, Hyun (Department of Emergency Medicine, Wonju College of Medicine, Yonsei University)
Hwang, Sung Oh (Department of Emergency Medicine, Wonju College of Medicine, Yonsei University)
Kim, Heon Ju (Department of Neurosurgery, Wonju College of Medicine, Yonsei University)
Publication Information
Journal of Trauma and Injury / v.18, no.2, 2005 , pp. 127-134 More about this Journal
Abstract
Purpose: Currently, there is a variety of systems available for predicting prognosis of trauma patients such as trauma score, Injury severity score (ISS) and acid-base variables. But it is not clear that the initial acid-base variables are predictors of prognosis in trauma patients at the emergency department. The objective of this study is to compare the base deficit, lactate and strong ion gap as an early predictor of mortality in trauma patients. Methods: Retrospective record review of 136 trauma patients needed to admit to intensive care unit via emergency department (June 2004 to February 2005). Data included age, injury mechanism, ISS, Revised trauma score (RTS), Multiple organ dysfunction score (MODS), Acute physiology and chronic health evaluation III (APACHE III), Glasgow coma scale (GCS), laboratory profiles, calculated anion gap and strong ion gap. Patients were divided into survivors and non-survivors, shock group and non-shock group with comparison by t-test;significance was assumed for p<0.05. Correlation between acid-base variables and mean arterial blood pressure (MABP) was evaluated. Results: There was a significant difference between the RTS (p=0.00), APACHE III (p=0.00), MODS (p=0.00), GCS (p=0.00) of survivors and non-survivors. There was no significant difference between the ISS (p=0.082), lactate (p=0.541), base excess (p=0.468) and SIG (p=0.894) of survivors and non-survivors. There was a significant difference between the RTS (p=0.023), APACHE III (p=0.002), lactate (p=0.000), base excess (p=0.000) and SIG (p=0.000) of shock and non-shock group. There was no significant difference between the ISS (p=0.270), MODS (p=0.442) and GCS (p=0.432) of shock and non-shock group. The base excess was most correlated to MABP (r2=0.150). Conclusion: Initial base deficit, serum lactate and SIG are not predictors of mortality in moderate to severe trauma patients. Initial base deficit, serum lactate and SIG are correlated with the mean arterial blood pressure in trauma patients in emergency department.
Keywords
Lactate; Base deficit; Strong ion gap; Trauma; Outcome;
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1 서준석, 이정호, 설동호, 최마이클승필, 서강석, 박정배 등. 외상환자에서의 손상정도와 혈청 유산염 및 염기결핍의 상관 관계. 대한응급의학회지 2003 ; 14 ; 425 - 33
2 Tisherman SA, Barie P, Bokhari F, Bonadies J, Daley B, Diebel L, et al. Clinical practice guideline :endpoints of resuscitation. J Trauma 2004;57;898- 912   DOI   ScienceOn
3 Nicolaou DD, Kelen GD, Acid-base disorders. In:Tintinalli JE, Kelen GD, Stapczynski S eds. Emergency Medicine. 6th ed.:McGraw-Hill, 2004; 149 - 59
4 Kellum JA, Kramer DJ, Pinsky MR. Strong ion gap: a methodology for explaining unexplained anions. J Crit Care 1995;10;51-5   DOI   ScienceOn
5 Balasubramanyan N, Havens PL, Hoffman GM. Unmeasured anions identified by the Fencl-Stewart method predict mortality better than base excess, anion gap, and lactate in patients in the pediatric intensive care unit. Crit Care Med 1999;27;1577-81   DOI   ScienceOn
6 Fujita M, Tsuruta R, Wakatsuki J, Takeuchi H, Oda Y, Kawamura Y, et al. Methanol intoxication: differential diagnosis from anion gap-increased acidosis. Intern Med 2004;43;750-4   DOI   ScienceOn
7 Kaplan LJ, Kellum JA. Initial pH, base deficit, lactate, anion gap, strong ion difference, and strong ion gap predict outcome from major vascular injury. Crit Care Med 2004;32;1120-4   DOI   ScienceOn
8 Hucker TR, Mitchell GP, Blake LD, Cheek E, Bewick V, Grocutt M et al. Identifying the sick:can biochemical measurements be used to aid decision making on presentation to the accident and emergency department. Br J Anaesth 2005;94;735-41   DOI   ScienceOn
9 Jones AE, Aborn LS, Kline JA. Severity of emergency department hypotension predicts adverse hospital outcome. Shock 2004;22;410-4   DOI   ScienceOn
10 Kincaid EH, Miller PR, Meredith IW, Rahman N, Chang MC. Elevated arterial base deficit in trauma patients:a marker of impaired oxygen utilization. J Am Coll Surg 1998;187;384-92   DOI   ScienceOn
11 Rixen D, Raum M, Bouillon B, Lefering R, Neugebauer E. Base deficit development and its prognostic significance in posttrauma critical illness: an analysis by the trauma registry of the Deutsche Gesellschaft fur unfallchirurgie. Shock 2001;15;83-9   DOI   ScienceOn
12 Daniel SR, Morita SY, Yu M, Dzierba A. Uncompensated metabolic acidosis:an underrecognized risk factor for subsequent intubation requirement. J Trauma 2004;57;993-7   DOI   ScienceOn
13 Martin M, Murray J, Berne T, Demetriades D, Belzberg H. Diagnosis of acid-base derangements and mortality prediction in the trauma intensive care unit:the physiochemical approach. J Trauma 2005 ; 58 ; 238 - 43   DOI   ScienceOn
14 Tremblay LN, Feliciano DV, Rozycki GS. Assessment of initial base deficit as a predictor of outcome:mechanism of injury does make a difference. Am Surg 2002;68;689-93   PUBMED
15 Figge J, Mydosh T, Fencl V. Serum proteins and acid-base equilibria:a follow-up. J Lab Clin Med 1992 ; 120 ; 713 - 9   PUBMED
16 Rocktaeschel J, Morimatsu H, Uchino S, Bellomo R. Unmeasured anions in critically ill patients:can they predict mortality? Crit Care Med 2003;31;2131-6   DOI   ScienceOn
17 Mikulaschek A, Henry SM, Donovan R, Scalea TM. Serum lactate is not predicted by anion gap or base excess after trauma resuscitation. J Trauma 1996 ; 40 ; 218 - 24   DOI   ScienceOn
18 Zehtabchi S, Sinert R, Baron BJ, Paladino L, Yadav K. Does ethanol explain the acidosis commonly seen in ethanol-intoxicated patients? Clin Toxicol (Phil) 2005;43;161-6   DOI
19 Smith I, Kumar P, Molloy S, Rhodes A, Newman PJ, Grounds RM, et al. Base excess and lactate as prognostic indicators for patients admitted to intensive care. Intensive Care Med 2001;27;74-83   DOI   ScienceOn
20 Estenssoro E, Gonzalez F, Laffaire E, Canales H, Saenz G, Reina R, et al. Shock on admission day is the best predictor of prolonged mechanical ventilation in the ICU. Chest 2005;127;598-603
21 Morimatsu H, Rocktachel J, Bellomo R, Uchino S, Goldsmith D, Gutteridge G. Comparison of point-ofcare versus central laboratory measurement of electrolyte concentrations on calculations of the anion gap and the strong ion difference. Anesthesiology 2003 ; 98 ; 1077 - 84   DOI   ScienceOn
22 Husain FA, Martin MJ, Mullenix PS, Steele SR, Elliott DC. Serum lactate and base deficit as predictors of mortality and morbidity. Am J Surg 2003 ; 185 ; 485 - 91   DOI   ScienceOn
23 Hatherill M, Waggie Z, Purves L, Reynolds L, Argent A. Correction of the anion gap for albumin in order to detect occult tissue anions in shock. Arch Dis Child 2002;87;526-9   DOI   ScienceOn
24 Cusack RJ, Rhodes A, Lochhead P, Jordan B, Perry S, Ball JA et al. The strong ion gap does not have prognostic value in critically ill patients in a mixed medical/surgical adult ICU. Intensive Care Med 2002;28;864-9   DOI   ScienceOn
25 Stewart PA. Modern quantitative acid-base chemistry. Can J Physiol Pharmacol 1983 ;61;1444-61   DOI   PUBMED   ScienceOn
26 Story DA, Morimatsu H, Bellomo R. Strong ions, weak acids and base excess:a simplified Fencl-Stewart approach to clinical acid-base disorders. Br J Anaesth 2004;92;54-60   DOI   ScienceOn
27 Rocktaeschel J, Morimatsu H, Uchino S, Goldsmith D, Poustie S, Story D, et al. Acid-base status of critically ill patients with acute renal failure:analysis based on Stewart-Figge methodology. Crit Care 2003 ; 7 ; 60 - 6
28 문준동, 김수진, 문철규, 최성혁, 전정민, 이성우 등. 중증 외상환자에서 염기 결핍수치의 유용성. 대한응급의학회지 2001 ; 12 ; 243 - 50
29 Kincaid EH, Chang MC, Letton RW, Chen JG, Meredith JW. Admission base deficit in pediatric trauma: a study using the national trauma data bank. J Trauma 2001;51;332-5   DOI   ScienceOn
30 Chawda MN, Hildebrand F, Pape HC, Giannoudis PV. Predicting outcome after multiple trauma:which scoring system? Injury 2004;35;347-58   DOI   ScienceOn