Predictive analysis of lactate clearance on the prognosis of patients with large burns
Abstract
Aims: To examine burn shock monitoring and the connection between lactate clearance and shock prognosis in individuals with severe burns. Materials and methods: This retrospective analysis comprised 100 patients with significant burns treated in our hospital between August 2017 and August 2021. The patients were split into two groups based on whether they survived or not: 50 cases each in the survival and death groups. Both groups had their blood lactate levels, partial pressure of oxygen, and other relevant indices tested. Analysis was done on the correlation between lactate level, lactate clearance, and death as well as the association between lactate clearance and prognosis at each time and point. Results: The lactate clearance rates at 6 h, 12 h, 24 h and 24 h in the survival group were greater than those in the death group, and the differences were significant (p < 0.05). The lactate clearance rates at each time point were compared at a cut-off of 20%, and patients with 6 h and 12 h blood lactate clearance rates ≥20.0% had lower prognostic morbidity and mortality rates than those <20.0%, with a significant difference (p < 0.05). Conclusion: Lactate clearance is directly correlated with the prognosis of patients with severe burns, and survivors also have a high clearance rate. As a result, in patients with severe burns, lactate clearance monitoring during the shock phase can improve prognostic prediction and enable early treatment plan modification based on outcomes.
References
1. Mohammed SN, Amin MA, ElHalim MMA, et al. Evaluation of Blood Lactate Concentrations as a Marker for Resuscitation and Prognosis in Patients with Major Burns. QJM: An International Journal of Medicine. 2023; 116. doi: 10.1093/qjmed/hcad069.688
2. Varghese R, Abdul Siyad AK, Haridas TV. Role of Serum Lactate as A Predictor of Mortality in Burns Patients> 15% Tbsa. International Journal of Academic Medicine and Pharmacy. 2023; 1347-1352.
3. Hu L, Wang B, Hong Y, et al. Admission Neutrophil-Lymphocyte Ratio (NLR) Predicts Survival in Patients with Extensive Burns. Burns. 2021; 47(3): 594-600. doi: 10.1016/j.burns.2020.07.028
4. Wang GY. Application and evaluation of hemodynamic monitoring in shock stage of extensive burns. Zhonghua Shao Shang Za Zhi. 2021; 37(2): 131-135. doi: 10.3760/cma.j.cn501120-20200916-00413. PMID: 33618449.
5. Hofmaenner DA, Steiger P, Schuepbach RA, et al. Safety of enzymatic debridement in extensive burns larger than 15% total body surface area. Burns. 2021; 47(4): 796-804. doi: 10.1016/j.burns.2020.10.012
6. Chen F, Xu L, Lv G, et al. Application of Multifunctional Intelligent Suspension Treatment Beds in Nursing Care of Patients with Extensive Burns. Teekaraman Y, ed. Contrast Media & Molecular Imaging. 2021; 2021: 1-6. doi: 10.1155/2021/8922504
7. Gao X, Zhang M, Lin Y, et al. Combined Complex Skin Repair in Patient with Extensive Burns: A Case Report. Journal of Burn Care & Research. 2021; 42(5): 1053-1056. doi: 10.1093/jbcr/irab037
8. Shen C, Deng H, Sun T, et al. Use of Fresh Scalp Allografts from Living Relatives for Extensive Deep Burns in Children: A Clinical Study Over 7 Years. Journal of Burn Care & Research. 2020; 42(2): 323-330. doi: 10.1093/jbcr/iraa155
9. Xu L, Jin J, Wu G, et al. Elevated serum procalcitonin early after extensive burn: influencing factors and clinical significance. Burns. 2021; 47(6): 1399-1407. doi: 10.1016/j.burns.2020.12.010
10. Chen Y, Peng J, Hu X, et al. Tissue oxygen saturation is predictive of lactate clearance in patients with circulatory shock. BMC Anesthesiology. 2023; 23(1). doi: 10.1186/s12871-023-02139-4
11. Alshiakh SM. Role of serum lactate as prognostic marker of mortality among emergency department patients with multiple conditions: A systematic review. SAGE Open Medicine. 2023; 11: 205031212211364. doi: 10.1177/20503121221136401
12. Zhuang M, Wang W, Cui Q, Sun Y. Successful coverage of extensive burns using only the scalp of an identical twin as donor with modified meek micrografting technique. Asian Journal of Surgery. 2022; 45(2): 788-791. doi: 10.1016/j.asjsur.2021.12.027
13. Pieptu V, Mihai A, Groza C, et al. Burns in the Emergency Department: A One-Year Single Center Analysis on 355 Cases. Chirurgia. 2020; 115(4): 486. doi: 10.21614/chirurgia.115.4.486
14. Swift K, Vujcich E, Matthews T, Reade MC. Caravan explosions: a case series of burns patients at the Royal Brisbane and Women’s Hospital. ANZ Journal of Surgery. 2020; 91(1-2): 73-76. doi: 10.1111/ans.16436
15. Kim S, Yoon J, Kym D, et al. Evaluating clinical heterogeneity and predicting mortality in severely burned patients through unsupervised clustering and latent class analysis. Scientific Reports. 2023; 13(1). doi: 10.1038/s41598-023-40927-7
16. Huang Z, Zhuang D, Xiong B, et al. Occupational exposure to SARS-CoV-2 in burns treatment during the COVID-19 epidemic: Specific diagnosis and treatment protocol. Biomedicine & Pharmacotherapy. 2020; 127: 110176. doi: 10.1016/j.biopha.2020.110176
17. Shi X, Zhong L, Lu J, et al. Clinical significance of the lactate-to-albumin ratio on prognosis in critically ill patients with acute kidney injury. Renal Failure. 2024; 46(1). doi: 10.1080/0886022x.2024.2350238
18. Abla H, Tran V, Pang A, et al. Assessing resuscitation in burn patients with varying degrees of liver disease. Burns. 2024; 50(4): 991-996. doi: 10.1016/j.burns.2024.01.022
19. Wang T, Chen K, Yao W, et al. Acetylation of lactate dehydrogenase B drives NAFLD progression by impairing lactate clearance. Journal of Hepatology. 2021; 74(5): 1038-1052. doi: 10.1016/j.jhep.2020.11.028
20. Legrand M, Clark AT, Neyra JA, et al. Acute kidney injury in patients with burns. Nature Reviews Nephrology. 2023; 20(3): 188-200. doi: 10.1038/s41581-023-00769-y
21. Eliud Kennedy M, Ferdinand Wanjala N, Peter Wambugu M, et al. Correlation of initial serum lactic acid and base deficit with early mortality in patients with major thermal burns at a Kenyan Tertiary Hospital. Burns Open. 2023; 7(2): 37-43. doi: 10.1016/j.burnso.2023.03.004
22. Kim M, Kym D, Hur J, et al. Tracking longitudinal biomarkers in burn patients with sepsis and acute kidney injury: an unsupervised clustering approach. European Journal of Medical Research. 2023; 28(1). doi: 10.1186/s40001-023-01268-3
23. Colak M, Arda Kilinc M, Güven R, et al. Procalcitonin and blood lactate level as predictive biomarkers in pediatric multiple trauma patients’ pediatric intensive care outcomes: A retrospective observational study. Medicine. 2023; 102(49): e36289. doi: 10.1097/md.0000000000036289
24. Hung TD, Lam NN. Risk Factors for Death of Burn Patients with Acute Respiratory Distress Syndrome. Ann Burns Fire Disasters. 2023; 36(4): 271-275.
25. Jouffroy R, Léguillier T, Gilbert B, et al. Prehospital lactate clearance is associated with reduced mortality in patients with septic shock. The American Journal of Emergency Medicine. 2021; 46: 367-373. doi: 10.1016/j.ajem.2020.10.018
26. Takahashi N, Nakada TA, Walley KR, Russell JA. Significance of lactate clearance in septic shock patients with high bilirubin levels. Scientific Reports. 2021; 11(1). doi: 10.1038/s41598-021-85700-w
27. Herrero De Lucas E, Sanchez-Sanchez M, Cachafeiro Fuciños L, et al. Lactate and lactate clearance in critically burned patients: usefulness and limitations as a resuscitation guide and as a prognostic factor. Burns. 2020; 46(8): 1839-1847. doi: 10.1016/j.burns.2020.06.003
28. Lestari MI, Sedono R, Zulkifli. Initial lactate levels versus lactate clearance for predicting mortality in sepsis: A prospective observational analytical study. J Pak Med Assoc. 2021; 71(2): S25-S29.
29. Marbach JA, Stone S, Schwartz B, et al. Lactate Clearance Is Associated with Improved Survival in Cardiogenic Shock: A Systematic Review and Meta-Analysis of Prognostic Factor Studies. Journal of Cardiac Failure. 2021; 27(10): 1082-1089. doi: 10.1016/j.cardfail.2021.08.012
30. Cartotto R, Johnson LS, Savetamal A, et al. American Burn Association Clinical Practice Guidelines on Burn Shock Resuscitation. Journal of Burn Care & Research. 2023; 45(3): 565-589. doi: 10.1093/jbcr/irad125
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