Use of Postoperative Peak Arterial Lactate Level to Predict Outcome After Cardiac Surgery.

Autor: Haanschoten MC; Department of Anaesthesiology, Catharina Hospital, Eindhoven, The Netherlands; Intensive Care Unit, Catharina Hospital, Eindhoven, The Netherlands., Kreeftenberg HG; Intensive Care Unit, Catharina Hospital, Eindhoven, The Netherlands., Arthur Bouwman R; Department of Anaesthesiology, Catharina Hospital, Eindhoven, The Netherlands; Intensive Care Unit, Catharina Hospital, Eindhoven, The Netherlands., van Straten AH; Department of Cardiothoracic Surgery, Catharina Hospital, Eindhoven, The Netherlands., Buhre WF; Department of Anaesthesiology, Maastricht University Hospital, Maastricht, The Netherlands., Soliman Hamad MA; Department of Cardiothoracic Surgery, Catharina Hospital, Eindhoven, The Netherlands. Electronic address: mohammed.soliman@catharinaziekenhuis.nl.
Jazyk: angličtina
Zdroj: Journal of cardiothoracic and vascular anesthesia [J Cardiothorac Vasc Anesth] 2017 Feb; Vol. 31 (1), pp. 45-53. Date of Electronic Publication: 2016 Apr 22.
DOI: 10.1053/j.jvca.2016.04.017
Abstrakt: Objectives: In the present study, the authors investigated the predictive value of postoperative peak arterial lactate levels for early and late mortality after cardiac surgery.
Design: Retrospective analysis of prospectively collected data.
Setting: Single-center study in an academic hospital.
Participants: Adult patients who underwent cardiac surgery between 2004 and 2014 (n = 16,376).
Interventions: Different cardiac surgical procedures.
Measurements and Results: Patients were classified according to the peak arterial lactate level (PALL) within 3 days postoperatively. Logistic regression analysis and Cox regression analysis were performed to identify postoperative peak arterial lactate level as a predictor for early and late mortality respectively. In 8460 patients (51.7%), lactate was not measured postoperatively because these patients were managed according to the fast-track protocol. These patients constituted group 1 in our population but were excluded from the regression analysis. The remaining patients (n = 7,916; 48.3%) were divided according to the postoperative peak arterial lactate level (PALL): PALL<5 mmol/L (group 2), PALL 5 to 10 mmol/L (group 3), and PALL of>10 mmol/L (group 4). Early mortality was 3.7%, 20.4%, and 62.9% in groups 2, 3, and 4 respectively (p<0.0001). This mortality rate was significantly higher than that of group 1 (1.6%); p<0.0001. Multivariate regression analyses revealed postoperative peak arterial lactate as a significant predictor of 30-day mortality (odds ratio = 1.44 [1.39-1.48], p<0.001) as well as for late mortality (hazard ratio = 1.05 [1.01-1.10], p<0.025).
Conclusions: Postoperative peak arterial lactate level in patients undergoing cardiac surgery is an independent predictor for both early and late mortality.
(Copyright © 2017 Elsevier Inc. All rights reserved.)
Databáze: MEDLINE
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