Effectiveness of Lactate Clearance to Predict In-Hospital Mortality in Patients with Upper Gastrointestinal Bleeding.

Objective: To determine the performance of lactate clearance to predict prognosis in patients with upper gastrointestinal bleeding (UGIB).

Study Design: Observational study. Place and Duration of the Study: Department of Emergency Medicine, Sisli Hamidiye Etfal Training and Research Hospital, Istanbul, Turkey, from January 2018 to 2022.

Methodology: This study was conducted with 141 patients with UGIB. Lactate clearance was calculated based on the lactate levels at the time of admission and 6th hour. The primary outcome was survival. The secondary outcomes were the need for intensive care unit, endoscopic intervention, blood transfusion, and length of hospital stay.

Results: The median age of the patients was 71 years and 65.2% were males. In the non-survivor group; systolic blood pressure, diastolic blood pressure, base deficit, delta lactate, and lactate clearance were significantly lower; however, heart rate, baseline lactate and final lactate were significantly higher. The median lactate clearance of survivors and non-survivors were 23.61 and -0.51, respectively (p = 0.002). A unit decrease in lactate clearance increased mortality 1.011-fold. The performance of lactate clearance in predicting mortality was followed as; sensitivity 76.4, specificity 51.4 (AUC = 0.673, p = 0.002), and the cut-off value was 21.51. Lactate clearance was not statistically significant in determining the need for intensive care (p = 0.110), endoscopic intervention (p = 0.152) and blood transfusion (p = 0.266) in UGIB.

Conclusion: Lactate clearance was an independent predictor of in-hospital mortality in UGIB. It is thought that the study will guide clinicians in the differentiation of critically-ill patients and an effective treatment planning.

Key Words: Upper gastrointestinal haemorrhage, Lactate, Lactate clearance, Mortality, endoscopy, Blood transfusion, Intensive care.