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KMID : 0191120170320111820
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Journal of Korean Medical Science
2017 Volume.32 No. 11 p.1820 ~ p.1827
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Lactate Parameters Predict Clinical Outcomes in Patients with Nonvariceal Upper Gastrointestinal Bleeding
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Lee Seung-Hoon
Min Yang-Won
Bae Joo-Hwan
Lee Hyuk
Min Byung-Hoon
Lee Jun-Haeng
Rhee Poong-Lyul
Kim Jae-J.
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Abstract
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The predictive role of lactate in patients with nonvariceal upper gastrointestinal bleeding (NVUGIB) has been suggested. This study evaluated several lactate parameters in terms of predicting outcomes of bleeding patients and sought to establish a new scoring model by combining lactate parameters and the AIMS65 score. A total of 114 patients with NVUGIB who underwent serum lactate level testing at least twice and endoscopic hemostasis within 24 hours after admission were retrospectively analyzed. The associations between five lactate parameters and clinical outcomes were evaluated and the predictive power of lactate parameter combined AIMS65s (L-AIMS65s) and AIMS56 scoring was compared. The most common cause of bleeding was gastric ulcer (48.2%). Lactate clearance rate (LCR) was associated with 30-day rebleeding (odds ratio [OR], 0.931; 95% confidence interval [CI], 0.872?0.994; P = 0.033). Initial lactate (OR, 1.313; 95% CI, 1.050?1.643; P = 0.017), maximal lactate (OR, 1.277; 95% CI, 1.037?1.573; P = 0.021), and average lactate (OR, 1.535; 95% CI, 1.137?2.072; P = 0.005) levels were associated with 30-day mortality. Initial lactate (OR, 1.213; 95% CI, 1.027?1.432; P = 0.023), maximal lactate (OR, 1.271; 95% CI, 1.074?1.504; P = 0.005), and average lactate (OR, 1.501; 95% CI, 1.150?1.959; P = 0.003) levels were associated with admission over 7 days. Although L-AIMS65s showed the highest area under the curve for prediction of each outcome, differences between L-AIMS65s and AIMS65 did not reach statistical significance. In conclusion, lactate parameters have a prognostic role in patients with NVUGIB. However, they do not increase the predictive power of AIMS65 when combined.
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KEYWORD
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AIMS65, Lactate, Mortality, Nonvariceal Upper Gastrointestinal Bleeding, Rebleeding
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