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J Korean Soc Emerg Med > Volume 30(1); 2019 > Article
Journal of The Korean Society of Emergency Medicine 2019;30(1): 33-42.
응급실로 내원한 산후 출혈 환자의 중증도 예측 인자로서 젖산 농도의 유용성
조영준1, 유제성1, 정성필1 , 좌민홍1 , 공태영1,2 , 고동률1 , 황윤정1, 이용희1, 박인철1, 김시내3
1연세대학교 의과대학 응급의학교실
2강원대학교 대학원 의학과 응급의학교실
3연세대학교 의과대학 연구부 통계지원실
The usefulness of lactate as an early predictor of the severity of emergency department patients with postpartum hemorrhage
Young Joon Cho1, Je Sung You1, Sung Phil Chung1 , Minhong Choa1 , Taeyoung Kong1,2 , Dong Ryul Ko1 , Yoon Jung Hwang1, Yong Hee Lee1, Incheol Park1, Sinae Kim3
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
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