The Role of Serum Lactate as a Prognostic Biomarker in Major Burn Patients: A Prospective Study

Document Type : Research article

Authors

The Department of Plastic, Burn and Maxillofacial Surgery, Faculty of Medicine, Ain Shams University

Abstract

Background: Severe burn results in a devastating and
unique derangement called burn shock. Fluid resuscitation is
the foundation of immediate burn care, and the primary goal
of resuscitation is to restore and preserve tissue perfusion. Historically,
resuscitation has been guided by a combination of
basic laboratory values, invasive maneuvers, and clinical data,
but the optimal guide to the end point of resuscitation remains
controversial.
Objective: The aim of this study is: To investigate the
diagnostic and prognostic validity of serum lactate in major
burn patients and to determine the utility of an initial and serial
serum lactate measurement during the first 36 hours for
identifying substantial risk of death and adequacy of fluid resuscitation.
Patients and Methods: 40 individuals who had significant
burns (greater than 20% of TBSA). Both operated and non-operated
patients are included. Twenty were female and twenty
were male of the forty cases. The research covered all adult
burn patients hospitalized during the first twenty-four hours
following their injury. Individuals who were released or died
48 hours after admission, or who were hospitalized after 24
hours following a thermal injury, were not included.
Results: As a prognostic tool, serial blood lactate measurements
performed better than solitary measurements. 24 hours
after admission, lactate levels that were reduced or returned to
normal were linked to a better chance of survival. Since serial
blood lactate measurements predict death in patients with
significant burns, this study validates the predictive utility of
serum lactate for mortality in these patients.
Conclusion: Our study demonstrated that lactate level in
major burn patients is a promising prognostic biomarker, that
could facilitate ideal management and initiate proper antimicrobial
therapy and good prognostic value as an early predictor
of mortality.

Keywords

Main Subjects

References

WHO (2019): Violence and Injury Prevention [Internet].
[cited 2019 Apr. 20].
2- Greenhalgh D.G.: Early management of burn patients
and fluid resuscitation. In Handbook of Burns. Springer,
Cham., 199-209; 1, 2020.
3- Jeschke M.G. and Gauglitz G.G.: Pathophysiology of
Burn Injuries. In Handbook of Burns Volume 1. Springer,
Cham. , pp. 229-245, 2020.
4- Haberal M., Abali A.E.S. and Karakayali H.: Fluid management
in major burn injuries. Indian journal of plastic
surgery, 43 (S 01): S29-S36, 2010.
5- D’souza N.T., Kujur A.R. and Rajeswari D.: Understanding
the role of serum lactate as an end point in burn resuscitation.
Indian Journal of Burns, 28 (1): 7, 2020.
6- Kearns R.D., Conlon K.M., Matherly A.F., Chung K.K.,
Bebarta V.S., Hansen J.J. and Palmieri T.L.: Guidelines for
burn care under austere conditions: Introduction to burn
disaster, airway and ventilator management, and fluid
resuscitation. Journal of Burn Care & Research, 37 (5):
e427-e439, 2016.
7- Pham T.N., Cancio L.C. and Gibran N.S.: American Burn
Association practice guidelines burn shock resuscitation.
Journal of Burn Care & Research, 29 (1): 257-266, 2008.
8- Nakajima M., Kojiro M., Aso S., Matsui H., Fushimi K.,
Kaita Y. and Yasunaga H.: Effect of high-dose vitamin
C therapy on severe burn patients: A nationwide cohort
study. Critical Care, 23 (1): 1-8, 2019.
9- Andersen L.W., Mackenhauer J., Roberts J.C., Berg K.M.,
Cocchi M.N. and Donnino M.W.: Etiology and therapeutic
approach to elevated lactate levels. In Mayo Clinic Proceedings.
Elsevier, 88 (10): 1127-1140, 2013.
10- Hayek S., Ibrahim A., Sittah G.A. and Atiyeh B.: Burn resuscitation:
Is it straightforward or a challenge? Annals of
burns and fire disasters, 24 (1): 17, 2011.
11- Mokline A., Abdenneji A., Rahmani I., Gharsallah L.,
Tlaili S., Harzallah I. and Messadi A.A.: Lactate: Prognostic
biomarker in severely burned patients. Annals of burns
and fire disasters, 30 (1): 35, 2017.
12- Vincent J.L., Angus D.C., Artigas A., Kalil A., Basson
B.R., Jamal H.H. and Bernard G.R.: Effects of drotrecogin
alfa (activated) on organ dysfunction in the PROWESS
trial. Critical Care Medicine, 31 (3): 834-840, 2003.
Vol. 48, No. 2 / The Role of Serum Lactate as a Prognostic Biomarker i 144 n Major Burn Patients
13- Smith I., Kumar P., Molloy S., Rhodes A., Newman P.J.,
Grounds R.M. and Bennett E.D.: Base excess and lactate
as prognostic indicators for patients admitted to intensive
care. Intensive Care Medicine, 27 (1): 74-83, 2001.
14- Husain F.A., Martin M.J., Mullenix P.S., Steele S.R. and
Elliott D.C.: Serum lactate and base deficit as predictors of
mortality and morbidity. The American Journal of Surgery,
185 (5): 485-491, 2003.
15- Cochran A., Edelman L.S., Saffle J.R. and Morris S.E.:
The relationship of serum lactate and base deficit in burn
patients to mortality. Journal of Burn Care & Research, 28
(2): 231-240, 2007.
16- Mikkelsen M.E., Miltiades A.N., Gaieski D.F., Goyal M.,
Fuchs B.D., Shah C.V. and Christie J.D.: Serum lactate is
associated with mortality in severe sepsis independent of
organ failure and shock. Critical Care Medicine, 37 (5):
1670-1677, 2009.
17- Khosravani H., Shahpori R., Stelfox H.T., Kirkpatrick
A.W. and Laupland K.B.: Occurrence and adverse effect
on outcome of hyperlactatemia in the critically ill. Critical
Care, 13 (3): 1-5, 2009.
18- Nichol A.D., Egi M., Pettila V., Bellomo R., French C.,
Hart G. and Cooper D.J.: Relative hyperlactatemia and
hospital mortality in critically ill patients: A retrospective
multi-center study. Critical Care, 14 (1): 1-9, 2010

Files

Share

How to cite

Statistics