The Role of Lactate for Sepsis in Polytrauma Patients: A Time-Related Analysis Using the IBM Watson Trauma Pathway Explorer®

Purpose: The Watson Trauma Pathway Explorer® is an outcome prediction tool invented by the University Hospital of Zurich in collaboration with IBM, representing an artificial intelligence application to predict the most adverse outcome scenarios in polytrauma patients: systemic inflammatory respiratory syndrome (SIRS), sepsis within 21 days, and death within 72 h. The question was how time-related lactate values would be associated with the incidence of sepsis.

Methods: Data from 3653 patients in an internal database, with ongoing implementation, served for analysis. Patients were split in 2 groups according to sepsis presence, and lactate values were measured at formerly defined time points from admission until 21 days after admission for both groups. Differences between groups were analyzed; time points with lactate as independent predictor for sepsis were identified. The predictive quality of lactate at 2 h and 12 h after admission was evaluated. Threshold values between groups at all time points were calculated.

Results: Lactate levels differed from less than 2 h after admission until the end of the observation period (21 days). Lactate represented an independent predictor for sepsis from 12 h to 48 h and 14 days to 21 days after admission relative to ISS levels. AUROC (area under the receiver operating characteristic curve was poor at 2 h and 12 h after admission with a slight improvement at the 12-h mark. Lactate levels decreased over time at a range of 2 (mmol/L) for 6 to 8 h after admission.

Conclusion: These insights may allow for time-dependent referencing of lactate levels and anticipation of subsequent sepsis, although further parameters must be considered for a higher predictability.

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