Determinants of Lactate Clearance and Mortality in Adult Patients with Severe Trauma

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Objective: To evaluate the association between initial blood lactate levels, blood lactate clearance (BLC) at 6 hours, and in-hospital mortality among patients with severe trauma. Material and Methods: This prospective observational study included 100 adult patients with severe trauma (Revised Trauma Score <6) admitted to a Level-I Trauma Center. Initial and 6-hour venous lactate levels were measured, and BLC was calculated. The endpoint was in-hospital mortality. Logistic regression was used to assess associations with in-hospital mortality and BLC.Results: The in-hospital mortality rate was 27%. Non-survivors had significantly higher initial lactate levels than survivors (14.2±6.4 vs. 5.7±2.2 mmol/L; p-value<0.01). In multivariate analysis, only initial lactate remained independently associated with mortality (adjusted OR 3.98; 95% CI: 1.30–9.71; p-value<0.001). Patients with low BLC (<10%) had significantly higher mortality than those with high BLC (40.0% vs. 7.9%; p-value=0.030), although no clinical variable independently predicted BLC.Conclusion: Initial blood lactate is a strong independent predictor of mortality in severe trauma. While BLC ≥10% is associated with improved survival, its determinants remain multifactorial. Serial lactate monitoring should be considered an integral part of early trauma care, especially in resource-limited settings.

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