jkss Journal of Korean Society of Spine Surgery Journal of Korean Spine Surg 2093-4378 2093-4386 Korean Society of Spine Surgery 10.4174/jkss.2011.80.2.84 jkss-80-84 Original Article Serum Lactate and Base Deficit: Early Predictors of Morbidity and Mortality in Burn Patients with Inhalation Injury ChoYong SukM.D. YangHyeong TaeM.D. YimHaejunM.D. KimDohernM.D. HurJunM.D. 1 KimJong HyunM.D. ChunWookM.D. Department of Burn Surgery, Burn Center, Hangang Sacred Heart Hospital, College of Medicine, Hallym University, Seoul, Korea Department of Pharmacology, Chung-Ang University College of Medicine, Seoul, Korea 02 2011 04 02 2011 80 2 84 89 19102010 10012011 Copyright © 2011 Korean Society of Spine Surgery 2011 This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. Abstract Purpose

The aim of this study was to elucidate whether plasma lactate (PL) and base deficit (BD) are useful early parameters to predict the prognosis of burn patients with inhalation injury. In addition, one of the main objectives was to evaluate if PL and its change, BD and its change due to fluid resuscitation, adds additional information.

 Methods

A retrospective review was performed on 151 patients admitted to our burn intensive care unit who were suspected to have inhalation burn injury, and then were confirmed by fibreoptic bronchoscopy between 1 Jan 2008 and 31 Dec 2008. All patients received proper fluid and electrolyte resuscitation, pain management, nutritional support, wound care and surgical debridement of dead tissue by burn surgeon.

 Results

Initial PL, PL1 (24 hours later) and initial BD show statistical differences between survivors group and non-survivors group. A better chance of survival occurs when resuscitation results in normal PL values within 24 h. Moreover, an outcome predictor of shock and effective resuscitation could be defined by evaluating the changes of BD on Day 1. Normalization of the BD within 24 h is associated with a better chance of survival.

 Conclusion

Measuring PL, BD and their changes may help to identify burn patients either for adequacy of treatment, or selection of other therapeutic options. Therefore titration of burn resuscitation to normalize PL and BD levels may be a reasonable method to improve burn mortality.

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The demographics of patients

Groups Value
Mean age (yrs) 43.1±14.1
Type of burn (Flame/Scald/Chemical) 147/3/1
Burn surface area (%TBSA) 33.4±30.0
Bronchoscopy (after admission) 1.6 days
ABSI (abbreviated burn severity index) score 8.48±3.56
Initial Co-Hb (%) 5.3±4.8
Base deficit (BD) (mmol/L) −5.03±4.54
Base deficit (BD) at 24 hrs later (mmol/L) 0.003±2.89
Lactate at admission (mmol/L) 4.2±3.4
Lactate at 24 hrs later (mmol/L) 2.96±2.0
Overall mortality (%) 21.2 (32 of 151)

Comparison of survivors and non-survivors

  Survivors Non-survivors P-value
ABSI score* 7.20 13.22 0.000
Initial Co-Hb (%)† 3.89 2.07 0.009
BD‡ at admission −4.57 −6.71 0.018
BD‡ at PBD1 −0.21 0.78 0.179
PL§ at admission 3.37 6.28 0.000
PL§ at PBD1 2.33 4.52 0.000

ABSI score = abbreviated burn severity index score;

Co-Hb (%) = carboxyhemoglobin;

BD = base deficit (mmol/L);

PL = plasma lactate (mmol/L).

Plasma lactate (PL) on Day (admission) and its changes on Day 1 and its related outcomes

PL related group (mmol/l) PL on Day 0 mortality rate in % Number of patients Normalized* PL on Day 1 mortality rate in % Number of patients Not normalized PL on Day 1 mortality rate, in % Number of patients
0∼2 0% 35 0% 29 0% 6
2.1∼4 24.2% 33 0% 9 25.0% 24
4.1∼6 37.5% 24 0% 7 41.2% 17
6.1∼8 78.6% 14 50% 2 75% 12
8.1∼ 44.5% 9 – 0 44.5% 9
Sum   115   47   68
P-value     0.000   0.004  

Normalized = it's changed with normal plasma lactate level (0∼2 mmol/L) within 24 hours after admission.

Base deficit (BD) on Day (admission) and its changes on Day 1 and its related outcomes

BD related group (mmol/l) BD on Day 0 mortality rate in % Number of patients Normalized* BD on Day 1 mortality rate in % patients Number of Not normalized BD on Day 1 mortality rate in % Number of patients
∼−6.1 30.0% 50 32.0% 25 28.0% 25
−6∼−2.1 21.0% 62 14.6% 41 33.3% 21
−2∼2 8.6% 35 4.5% 22 15.4% 13
2∼ 25.0% 4 – 0 25.0% 4
Sum   151   88   63
P-value     0.038   0.008  

Normalized = it's changed with normal base deficit level (0∼2 mmol/L) within 24 hours after admission.