UTILIDAD DEL LACTATO COMO PREDICTOR DE LA NECESIDAD DE TRATAMIENTO EN LA HEMORRAGIA GASTROINTESTINAL ALTA EN COMPARACIÓN CON LA ESCALA DE BLATCHFORD

Abstract

INTRODUCTION: The clinical guides and international consensuses recommend the early stratification in patients with upper gastrointestinal hemorrhage (UGH) in low and high risk categories through the use of validated scales for prognosis. In this study patients with UGH were evaluated to determine the usefulness of the serum lactate as predictor of the need of treatment and it was also compared to the Blatchford scale. OBJETIVE: To determine serum lactate usefulness to predict the need of treatment in upper gastrointestinal hemorrhage. MATERIALS AND METHODS: 171 patients undergoing UGH went through predictive testing with serum lactate and compared to Blatchford scale of high risk patients in need of treatment. Requirements for the treatments were determined by a follow-up to the evolution of the patients. STATISTICAL ANALYSIS: Sensibility, specificity, predictive positive value, predictive negative value, proportion of false positives, proportion of false negatives, accuracy and odds ratio diagnostic were calculated. ROC curves compared the accuracy of both tests and the cut-off point allowed us to decide for the lactate as predictor of need of treatment in the patients having UGH. RESULTS: As for the test of the lactate the measurements of usefulness were: sensibility 69.7 %, specificity 72.4 %, predictive positive value 92.5 %, predictive negative value 32.8 %, proportion of false negatives 30.3 %, accuracy 70.2% and odds ratio diagnostic 6.04 %. In the ROC curve, the area under the curve “Utilidad del lactato como predictor de la necesidad de tratamiento en la hemorragia gastrointestinal alta en comparación con la escala de Blatchford” 2011 Página XV for the serum lactate was 0.716 and for Blatchford's scale 0.718. The best cut-off point for the serum lactate was 1.850 mmol/l. CONCLUSIONS: The determination of serum lactate is useful to stratify the patients with UGH into high risk that needed treatment, since it provides a predictive positive value of 92.5 % and an accuracy similar to that of Blatchford's scale.