Identification of prognostic markers in clinical decision making on massive blood transfusions in parturient women with blood loss
Keywords:obstetric hemorrhages, blood transfusion, lactate level
Background. Obstetric hemorrhage is the leading cause of maternal mortality worldwide. According to the World Health Organization, massive bleeding in parturient women, along with infectious complications and preeclampsia, determine up to 75 % of cases of maternal mortality. The purpose of the study was to identify prognostic markers in clinical decision making for massive blood transfusions in parturient women with blood loss. Materials and methods. The study included 38 parturient women in whom childbirth was complicated by blood loss. The average age of the subjects was 27.4 ± 4.1 years, weight — 83.3 ± 4.8 kg. The number of first-time mothers was 18 patients (47.4 %), multipara — 20 mothers (52.6 %). Postpartum blood loss averaged 1,830.5 ± 622.7 ml. All bleedings were stopped according to current protocols. Results. The analysis showed that indicators such as the level of fibrinogen (p = 0.0223) and lactate (p = 0.0137) had statistical differences in the study groups with massive blood transfusions and moderate blood transfusions. One-dimensional logistic regression analysis gave an odds ratio of 0.95 (95% confidence interval (CI), 0.96–0.98) for fibrinogen and 1.7 (95% CI, 1.1–3.14) for lactate, and an odds ratio for shock index was 1.45 (95% CI, 0.46–4.52). The area under the ROC-curves (AUC) for fibrinogen, lactate and shock index was 0.805 (95% CI, 0.612–0.927), 0.722 (95% CI, 0.528–0.869) and 0.588 (95% CI, 0.381–0.780), respectively. The limit value of fibrinogen 2.13 g/l had a sensitivity and specificity of 0.91 and 0.55, respectively. At the same time, the limit value of lactate, equal to 4 mmol/l, had a sensitivity and specificity of 0.69 and 0.66, respectively. AUC for lactate was significantly higher than for shock index, the difference in AUC between these indicators was –0.134 (95% CI, 0.275 to –0.012) (p = 0.052). The lactate threshold of 4 mmol/l had a sensitivity and specificity of 0.69 and 0.66, respectively, while the threshold for the shock index of 1.2 had a sensitivity and specificity of 0.64 and 0.35, respectively. Conclusions. Lactate was a better prognostic marker in the clinical decision to conduct massive blood transfusions, compared with the generally accepted shock index in patients with postpartum blood loss. Lactate measurement may be useful for activating the massive blood transfusions protocol and for promoting the onset of active hemostasis procedures.
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