Venous lactate level as a predictor to determine the outcome in patients with acute upper gastrointestinal hemorrhage in the emergency department
Nitesh Kumar1, Diwakar Verma1, Kapil Gupta2, Madhu Kiran3, Shatrughan Pareek4, Mahish Mehta5
1 Department of Emergency Medicine, All India Institute of Medical Sciences (AIIMS), MIA, 1st Phase, Basni 2, Jodhpur 342005, Rajasthan, India
2 Department of Emergency Medicine, Manipal Hospital, Palam Vihar, Sector 6 Dwarka, New Delhi 110075, India
3 Department of Emergency Medicine, Shantiram Medical College and Hospital, NH-40, Nadhyala, Andhra Pradesh 518001, India
4 Department of Nursing, Indian Railway Health Services, Bikaner, Rajasthan 334005, India
5 Department of Emergency Medicine, Max Super Speciality Hospital, Saket, Delhi 110017, India
Mr. Shatrughan Pareek
Department of Nursing, Indian Railway Health Services, Bikaner, Rajasthan.
Source of Support: None, Conflict of Interest: None
Introduction: Gastrointestinal bleeding (GIB) is occasionally seen in various clinical conditions in emergency departments (EDs). It is associated with more disease burden and mortality. Most severe patients with upper GIB (UGIB) have an increased level of lactate, whereas it is still not considering a risk predictor among the patients. The present study aimed to evaluate several levels and a cut-off value of lactate for predicting outcomes of patients with UGIB. Materials and Methods: The present cross-sectional observational prospective study was conducted in the ED of Max Hospital, Saket, New Delhi, over a study period of 18 months from June 2015 to December 2016. The participants selected for the study were more than 17 years old from both genders with UGIB. In the study, 300 subjects were selected by the convenient sampling method. All the analyses was done by SPSS-20. Results: In this study, male and female subjects were 75.7% and 24.3%, respectively. Nearly 25% of the participants were hypertensive and diabetic. The study highlighted that the mean lactate level was 4.55±2.45 mmol/L; however, the range of the lactate level was 1.4–14. Based on the receiver operating characteristic curve analysis, the optimum cutoff of lactate was 4.55 mmol/L, had an area under the curve of 0.905 (confidence interval: 0.861–0.949), sensitivity of 80.5%, specificity of 98.9%, and P-value of less than 0.05. Likewise, the results of this study also communicated that there was a significant positive correlation (P-value = 0.001*) between the level of lactate and the outcome of the patients. The present study also discriminated that venous lactate levels 4.55 mmol/L and above are associated with mortality and hospital stay. Conclusion: Findings of this research study suggested that venous lactate level is an effective predictor of patient outcome among patients with UGIB. Furthermore, early assessment and management are needed to reduced mortality and morbidity among patients with UGIB.