Objective: To assess the predictive value of 24 hour lactate clearance rate (LCR) for postoperative mortality, multiple organ dysfunction syndrome (MODS), and other clinical outcomes in patients with severe abdominal blunt trauma undergoing emergency laparotomy. Methods: A retrospective cohort study was conducted on 348 patients with severe abdominal blunt trauma (American Association for the Surgery of Trauma [AAST] organ injury grade ≥ III) admitted to a Level 1 trauma center from January 2021 to December 2024. Venous lactate levels were measured on admission, and at 6, 12, and 24 hours postoperatively. LCR was calculated as [(admission lactate − 24 hour lactate)/admission lactate] × 100%. Patients were stratified by the optimal LCR cutoff value (≥25% vs. <25%) determined via receiver operating characteristic (ROC) curve analysis. Primary outcomes included 30 day postoperative mortality and MODS incidence within 7 days. Secondary outcomes encompassed intensive care unit (ICU) length of stay, total hospital stay, and unplanned reoperation rate. Results: The optimal LCR cutoff for predicting 30 day mortality was 25%, with an area under the curve (AUC) of 0.83, sensitivity of 85.1%, and specificity of 78.2%. Patients with LCR ≥25% had significantly lower 30 day mortality (6.7% vs. 35.2%, P<0.001) and MODS incidence (9.2% vs. 48.1%, P<0.001) compared to those with LCR <25%. Multivariate logistic regression confirmed LCR <25% as an independent risk factor for 30 day mortality (OR=5.89, 95% CI=3.21–10.83, P<0.001) and MODS (OR=6.72, 95% CI=3.68–12.26, P<0.001). Additionally, the LCR ≥25% group had shorter ICU stay (4.8 ± 1.5 days vs. 13.2 ± 3.8 days, P<0.001), shorter total hospital stay (13.6 ± 2.9 days vs. 28.1 ± 6.2 days, P<0.001), and lower unplanned reoperation rate (4.1% vs. 18.7%, P<0.001). Conclusion: The 24 hour lactate clearance rate is a reliable, cost effective predictor of postoperative outcomes in patients with severe abdominal blunt trauma. An LCR <25% identifies patients at high risk of adverse outcomes, warranting intensified monitoring and targeted intervention.
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