The usefulness of lactate as an early predictor of the severity of emergency department patients with postpartum hemorrhage

¹Department of Emergency Medicine, Yonsei University College of Medicine, Seoul
²Department of Emergency Medicine, Graduate School of Medicine, Kangwon National University, Chuncheon
³Department of Research Affairs, Biostatistics Collaboration Unit, Yonsei University College of Medicine, Seoul, Korea

Correspondence

Taeyoung Kong ,Tel: 02-2019-3030, Fax: 02-2019-4820, Email: grampian@yuhs.ac,

Received: July 20, 2018; Revised: September 29, 2018 Accepted: October 5, 2018. Published online: February 28, 2019.

ABSTRACT

Objective:
Only a few studies have examined the role of lactate reflecting on tissue hypoperfusion determining the severity of postpartum hemorrhage (PPH) patients in the emergency department (ED). This study evaluated the utility of the arterial lactate level as a prognostic marker of severity in PPH patients admitted to an ED.
Method:
This retrospective, observational cohort study was conducted on patients integrated prospectively in a critical pathway of SPEED (Severance Protocol to save postpartum bleeding through Expeditious care Delivery). Adult primary PPH patients admitted to the ED between July 1, 2010 and March 31, 2017 were analyzed. The outcomes were the development of severe PPH including death, hysterectomy, surgical treatment, and massive transfusion.
Results:
A total of 112 patients were enrolled in this study. An increase in the arterial lactate value was a strong independent predictor of severe PPH. The increasing predictability of severe PPH was closely associated with an arterial lactate ≥3.15 mL/L at admission (odds ratio, 13.870; P<0.001).
Conclusion:
Lactate is an independent predictor of severe PPH and is suitable for a rapid and simple estimation of the severity of PPH. Emergency physicians can use lactate to determine the initial treatment strategies more precisely.

Key words: Postpartum hemorrhage; Prognosis; Lactic acid