Validación del clearance de lactato como predictor de mortalidad en pacientes con trauma moderado y severo. Hospital Vicente Corral Moscoso. Cuenca, 2017

Abstract

Introduction: The prevalence of mortality in patients with trauma can reach high figures, in Ecuador, the main cause of mortality from injuries are traffic accidents, for this reason, there is great interest to improve the early detection of critically ill patients, for provide intensive and adequate management. Objective: To determine the validity of lactate clearance as a predictor of mortality in patients with moderate and severe trauma. Hospital Vicente Corral Moscoso, Cuenca 2017. Method and materials: A validation study of diagnostic tests was performed in patients with moderate to severe trauma, a blood sample was taken for serum lactate at the time of admission and at 6 hours to quantify the lactate clearance and compared with the REMS scale(Rapid Emergency Medicine Score) (pattern of gold), the outcome variable was mortality. Results: 149 patients who met the inclusion criteria were studied, a mortality prevalence of 22.1% was found. The mean age was found to be 39.91 SD ± 18.92; a sensitivity and specificity was found for the lactate of admission of 84.85% and 56.9%; a sensitivity and specificity for lactate at 6 hours of 87.88% and 73.28%; the area under the lactate curve both at admission and at 6 hours was greater than 0.8. The clearance of lactate showed a sensitivity of 72.73%, and specificity of 75.86%. A cut-off point of 2.5 was determined for the lactate of admission and of 1.93 for the lactate of 6 hours. Conclusions: the 6-hour lactate presents a better predictor for mortality in patients with trauma, while the lactate clearance achieved high sensitivity and specificity for surveillance of resuscitation.