Revista do Colégio Brasileiro de Cirurgiões
https://revistadocbc.org.br/article/doi/10.1590/0100-6991e-2026005525
Revista do Colégio Brasileiro de Cirurgiões
Artigo Original

Variação de indicadores de choque na gasometria arterial e prognóstico de pacientes vítimas de trauma grave

Variations in shock indicators in arterial blood gas analysis and prognosis in patients with severe trauma

Jihad Manaf El Sayed; William Jorge Alves Antonio; Adilia Maria Pires Sciarra; Lilian Castiglioni; Paulo César Espada

http://dx.doi.org/10.1590/0100-6991e-2026005525 RCBC, vol.53, e2026005525, 2026
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Resumo

Introdução: indicadores de choque na gasometria arterial no contexto de trauma são ferramentas fundamentais para o diagnóstico precoce, quando sinais clínicos ainda não estão presentes. O estudo objetivou analisar o potencial papel prognóstico que esses indicadores podem assumir na avaliação do paciente vítima de trauma.

Métodos: estudo retrospectivo com 294 pacientes vítimas de trauma grave atendidos entre 2016 e 2025 em hospital terciário. Foram incluídos apenas os pacientes com gasometria na admissão e após 24 horas, ativação do protocolo de transfusão maciça e laparotomia exploradora.

Resultados: dos 294 pacientes, 74 (25,2%) evoluíram para óbito. A variação do lactato foi significativamente maior nos pacientes que morreram (p < 0,001). A AUC da curva ROC foi de 0,6949, com sensibilidade de 72%, especificidade de 98,5% e valor preditivo positivo de 96,4%. A odds ratio para óbito em pacientes com aumento do lactato ≤1 mmol/L foi de 167,14. Já a variação do excesso de base não teve significância estatística (p = 0,054), com AUC de 0,5748. Houve correlação fraca entre a variação do excesso de base e o desfecho (r = -0,1124; p = 0,0063), e correlação fraca a moderada para a variação do lactato (r = 0,2931; p < 0,0001). Também houve associação significativa entre desfecho e idade, escore de coma de Glasgow e parâmetros laboratoriais de admissão e 24h.

Conclusão: a variação do lactato nas primeiras 24 horas associou-se à mortalidade em pacientes com trauma grave e apresentou desempenho prognóstico superior ao excesso de base nesta amostra, com capacidade discriminatória moderada.

Palavras-chave

Ácido Láctico; Choque; Cuidados de Suporte Avançado de Vida no Trauma; Gasometria; Transtornos da Coagulação Sanguínea

Abstract

Introduction: Shock indicators in arterial blood gas analysis in the context of trauma are essential tools for early diagnosis, when clinical signs are not yet present. The study aimed to analyze the potential prognostic role these indicators may play in the evaluation of trauma patients.

Methods: A retrospective study of 294 patients with severe trauma treated between 2016 and 2025 at a tertiary care hospital. Only patients with blood gas analysis at admission and after 24 hours, activation of the massive transfusion protocol, and exploratory laparotomy were included.

Results: Of the 294 patients, 74 (25.2%) died. Lactate variation was significantly higher in patients who died (p < 0.001). The AUC of the ROC curve was 0.6949, with a sensitivity of 72%, specificity of 98.5%, and positive predictive value of 96.4%. The odds ratio for death in patients with an increase in lactate ≤1 mmol/L was 167.14. In contrast, the variation in base excess was not statistically significant (p = 0.054), with an AUC of 0.5748. There was a weak correlation between the variation in base excess and the outcome (r = -0.1124; p = 0.0063), and a weak to moderate correlation for the variation in lactate (r = 0.2931; p < 0.0001). There was also a significant association between outcome and age, Glasgow Coma Scale score, and laboratory parameters at admission and 24 hours.

Conclusion: Lactate variation in the first 24 hours was associated with mortality in patients with severe trauma and demonstrated superior prognostic performance compared to base excess in this sample, with moderate discriminatory power.

Keywords

Lactic Acid; Shock; Advanced Trauma Life Support; Arterial Blood Gas Analysis; Blood Coagulation Disorders

Referências

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Submetido em:
01/12/2025

Aceito em:
05/05/2026

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