Serum lactate and base deficit as prognostic markers in acute burns patients.

Abstract

Resuscitation of burns remains a fundamental problem in burn care. Traditional endpoints such as mean arterial pressure and urine output guide fluid therapy for optimal resuscitation, but an ideal marker remains controversial. Base deficit and serum lactate are markers of global tissue acidosis and inadequate oxygenation. The aim of this study was to determine whether serum lactate and base deficit together can be used as prognostic markers in acute burns and their association with sepsis and mortality. A prospective observational study with a sample size of 250 was conducted over 18 months, which included patients with 20-60% total body surface area (TBSA) having thermal burns or scald. Resuscitation was done according to hospital protocol and fluid administration was adapted according to clinical parameters. Serum lactate and base deficit values were analysed at the time of admission, then on day one, two, three and finally on day seven after admission. The two parameters were compared among survivors and non survivors. Patients were followed up till discharge, death or 30^th post burn day. Baseline serum lactate levels are high and base deficit levels low in the patients sustaining burns and the levels normalised over seven days with adequate resuscitation in survivors. Persistently high serum lactate and low base deficit are associated with sepsis and increased mortality. This study indicates that serum lactate and base deficit are useful parameters to predict mortality and promising predictive tools for assessing resuscitation and development of sepsis. Using these tools to guide fluid resuscitation may help mortality and improve overall outcomes.