Systematic review on peri‐operative lactate measurements to predict outcomes in patients undergoing liver resection
| Autor: | Stefan Stättner, Catherine E. Connolly, Thomas Niederwieser, Florian Primavesi |
|---|---|
| Rok vydání: | 2020 |
| Předmět: |
medicine.medical_specialty
Cirrhosis complications Review Article 03 medical and health sciences Postoperative Complications 0302 clinical medicine Predictive Value of Tests Internal medicine Acute care Diabetes mellitus medicine Hepatectomy Humans lactate Predictive marker Hepatology business.industry liver failure Perioperative Prognosis medicine.disease Triage Transplantation Systematic review 030220 oncology & carcinogenesis liver resection outcome Lactates 030211 gastroenterology & hepatology Surgery business Biomarkers |
| Zdroj: | Journal of Hepato-Biliary-Pancreatic Sciences |
| ISSN: | 1868-6982 1868-6974 |
| DOI: | 10.1002/jhbp.727 |
| Popis: | Lactate measurements have proven utility as a triage tool, therapeutic guide, and prognostic indicator, with broad use in Acute Care and transplantation. Its value in guiding therapy and predicting outcomes following liver resection is less well‐defined. This systematic review in accordance with Preferred Reporting Items for Systematic Reviews and Meta‐Analyses guidelines assessed the relationship between peri‐operative lactate levels and morbidity and mortality after liver resection. Seven relevant studies comprising 2573 patients in total were identified. Six studies assessed intra‐operative or early postoperative lactate levels, one publication examined pre‐operative levels. All studies demonstrated a significant association between peri‐operative lactate levels and adverse outcomes. The influence of pre‐operative diabetes and cirrhosis on postoperative lactate levels was shown in one study each, no study assessed the association of lactate with post‐hepatectomy liver failure according to defined criteria. The heterogeneity of study measurements and end‐points precluded a meta‐analysis from being performed. Early postoperative lactate >3‐3.7 mmol/L is associated with mortality but validation of clear cut‐off levels for outcome prediction is pending. Literature suggests lactate is a useful predictive marker for outcomes post liver surgery, especially when measured in the early postoperative phase. Further research is required to standardize the use of lactate measurements in a meaningful therapeutic manner. Highlight In this systematic review of seven studies analyzing pre‐, intra‐ or postoperative lactate levels in 2573 patients, Connolly et al demonstrated that lactate levels at all time‐points were associated with post‐hepatectomy outcomes, and early postoperative lactate predicted mortality. Possible clinical applications include adaption of intraoperative strategies and intensification of postoperative management. |
| Databáze: | OpenAIRE |
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