-Original-

Utility of Measurement of Serum Lactate in Diagnosis of Coagulopathy Associated with Peripheral Circulatory Insufficiency: Retrospective Evaluation Using Thromboelastometry from a Single Center in Japan

Hiroyuki Koami¹, Yuichiro Sakamoto¹, Ryota Sakurai¹, Miho Ohta¹, Akiko Goto¹, Hisashi Imahase¹, Mayuko Yahata¹, Mitsuru Umeka¹, Toru Miike¹, Futoshi Nagashima¹, Takashi Iwamura¹, Kosuke Chris Yamada¹ and Satoshi Inoue²

¹Department of Emergency and Critical Care Medicine, Saga University, Saga, Japan
²Division of Trauma Surgery and Surgical Critical Care, Saga University, Saga, Japan

Recently, serum lactate level rather than systolic blood pressure (sBP) has been widely used to diagnose peripheral circulatory insufficiency, which often leads to coagulopathy with systemic inflammation. However, most of the reported disorders were examined by plasma samples. The aim of this study was to evaluate the utility of serum lactate for detecting coagulopathy with circulatory failure by using thromboelastometry as well as standard coagulation test. 192 adult patients transported to our hospital between January 2013 and September 2014 were enrolled in this retrospective study. The sBP, serum lactate and thromboelastometry (ROTEM^®) were measured in these patients in the emergency department. All patients were divided into three groups based on serum lactate levels: (1) the severe group (≥4 mmol/L, n=41); (2) the mild group (<4 mmol/L and ≥2 mmol/L, n=59); and (3) the normal group (<2 mmol/L, n=92). Patients in the severe group were of a significantly younger age but had lower pH and poor outcome. SBP was significantly lower and heart rates were higher in the severe group than in the other groups. Prolonged PT-INR and APTT were statistically confirmed in the severe group. ROTEM findings in the severe group revealed significantly lower alpha angle, shortened Lysis Onset Time and significantly more cases exhibited hyperfibrinolysis. The same analysis with the cut-off level of sBP at 90 mmHg showed no significant difference in ROTEM findings between the two groups. Abnormal serum lactate levels (≥4.0 mmol/L) properly reflected peripheral circulatory insufficiency and were more closely associated with coagulopathy such as hyperfibrinolysis and hypocoagulability than sBP.

J Nippon Med Sch 2016; 83: 150-157

Keywords
systemic inflammation, thromboelastometry, lysis onset time, hyperfibrinolysis, prognosis

Correspondence to
Hiroyuki Koami, Department of Emergency and Critical Care Medicine, Saga University, 5-1-1 Nabeshima, Saga City, Saga 849-8501, Japan
hkoami@cc.saga-u.ac.jp

Received, December 1, 2015
Accepted, April 14, 2016