Prognostic significance of blood lactate and lactate clearance in trauma patients

Anesthesiology. 2012 Dec;117(6):1276-88. doi: 10.1097/ALN.0b013e318273349d.


Background: Lactate has been shown to be a prognostic biomarker in trauma. Although lactate clearance has already been proposed as an intermediate endpoint in randomized trials, its precise role in trauma patients remains to be determined.

Methods: Blood lactate levels and lactate clearance (LC) were calculated at admission and 2 and 4 h later in trauma patients. The association of initial blood lactate level and lactate clearance with mortality was tested using receiver-operating characteristics curve, logistic regression using triage scores, Trauma Related Injury Severity Score as a reference standard, and reclassification method.

Results: The authors evaluated 586 trauma patients (mean age 38±16 yr, 84% blunt and 16% penetrating, mortality 13%). Blood lactate levels at admission were elevated in 327 (56%) patients. The lactate clearance should be calculated within the first 2 h after admission as LC0-2 h was correlated with LC0-4 h (R=0.55, P<0.001) but not with LC2-4 h (R=0.04, not significant). The lactate clearance provides additional predictive information to initial blood lactate levels and triage scores and the reference score. This additional information may be summarized using a categorical approach (i.e., less than or equal to -20 %/h) in contrast to initial blood lactate. The results were comparable in patients with high (5 mM/l or more) initial blood lactate.

Conclusions: Early (0-2 h) lactate clearance is an important and independent prognostic variable that should probably be incorporated in future decision schemes for the resuscitation of trauma patients.

MeSH terms

  • Adult
  • Aged
  • Biomarkers / blood
  • Cohort Studies
  • Female
  • Humans
  • Injury Severity Score*
  • Lactic Acid / blood*
  • Lactic Acid / pharmacokinetics
  • Male
  • Metabolic Clearance Rate / physiology
  • Middle Aged
  • Prognosis
  • Prospective Studies
  • Wounds and Injuries / blood*
  • Wounds and Injuries / diagnosis*
  • Young Adult


  • Biomarkers
  • Lactic Acid