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A New Severity Predicting Index for Hemorrhagic Shock Using Lactate Concentration and Peripheral Perfusion in a Rat Model.
MedLine Citation:
PMID:  23143055     Owner:  NLM     Status:  Publisher    
Abstract/OtherAbstract:
ABSTRACT: Forty percent of trauma deaths are due to hemorrhage, with 33% to 56% occurring in the prehospital environment. This study proposes a new index (NI) based on the ratio of serum lactate concentration to peripheral perfusion, as an indicator of hemorrhage-induced mortality during the pre-hospital stage. Thirty-six anesthetized rats were randomized into three groups according to volume of controlled blood loss. We measured heart rate (HR), systolic and diastolic blood pressures (SBP and DBP), mean arterial pressure (MAP), pulse pressure (PPR), respiration rate (RR), temperature (TEMP), lactate concentration (LC), peripheral perfusion (PP), shock index (SI, heart rate/systolic blood pressure), and proposed the new hemorrhage-induced mortality index (NI, NI=LC/PP). Peripheral perfusion, defined as peripheral tissue perfusion and skin microcirculation, was continuously monitored by laser Doppler flowmetry. All parameters were analyzed for changes between pre- and posthemorrhage to investigate the effects of hemorrhage on mortality. Areas under a receiver operating characteristic curve (AUC) in descending order for NI, SI, PP, SBP, MAP, PPR, DBP, TEMP, LC, RR, and HR were 0.975, 0.941, 0.922, 0.919, 0.903, 0.884, 0.847, 0.816, 0.783, 0.744, and 0.672, respectively. The correlation coefficients with mortality for NI, SI, PP, SBP, MAP, PPR, DBP, TEMP, LC, RR, and HR were -0.818, -0.759, 0.726, 0.721, 0.694,0.662, 0.597, 0.544, -0.487, 0.420, and -0.296, respectively, with the same order as the AUC. NI was shown to be an optimal independent mortality predictor on multivariable logistic regression analysis. In conclusion, the newly proposed hemorrhage-induced mortality index, based on blood lactate/peripheral perfusion ratio, was a better marker for predicting mortality in rats undergoing acute hemorrhage in comparison to the other parameters evaluated in this study.
Authors:
Joon Yul Choi; Wan Hyung Lee; Tae Keun Yoo; Incheol Park; Deok Won Kim
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2012-11-8
Journal Detail:
Title:  Shock (Augusta, Ga.)     Volume:  -     ISSN:  1540-0514     ISO Abbreviation:  Shock     Publication Date:  2012 Nov 
Date Detail:
Created Date:  2012-11-12     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  9421564     Medline TA:  Shock     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Affiliation:
1 Department of Medical Engineering, Yonsei University College of Medicine 2 Brain Korea 21 Project for Medical Science, Yonsei University 3 Department of Medicine, Yonsei University College of Medicine, 4 Department of Emergency Medicine, Yonsei University College of Medicine, Seoul, South Korea.
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