Abstract
Background
Gastrointestinal hemorrhage (GIH) is a common complaint seen in the emergency department
(ED) and carries a small but significant mortality rate. The principal purpose of
this investigation was to determine whether an ED venous lactate as part of initial
laboratory studies is predictive of mortality in patients admitted to the hospital
for GIH.
Methods
Retrospective cohort study for 6 years at an urban tertiary referral hospital included
all ED patients with the charted diagnosis of acute GIH. Serum lactate was drawn at
the bedside as part of patient care after arrival to the ED at the discretion of the
clinical team. Clinical parameters and inpatient mortality were collected from the
medical record. Optimal cut points for lactate were derived using receiver operating
characteristics curves and imputed into a multivariable logistic regression model.
Results
Of the 2834 medical records that had GIH diagnoses, 1644 had an ED lactate recorded.
A lactate greater than 4 mmol/L conferred a 6.4-fold increased odds of in-hospital
mortality (94% specificity, P < .001). Controlling for age, initial hematocrit, and heart rate, every 1-point increase
in lactate conferred a 1.4-fold increase in the odds of mortality.
Conclusions
Elevated initial lactate drawn in the ED can be associated with in-hospital mortality
for ED patients with acute GIH. Prospective validation studies are warranted.
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Article Info
Publication History
Published online: February 19, 2014
Accepted:
February 10,
2014
Received in revised form:
February 10,
2014
Received:
January 12,
2014
Footnotes
☆Disclosures: None.
Identification
Copyright
© 2014 Elsevier Inc. Published by Elsevier Inc. All rights reserved.
