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

Marco C. Haanschoten, Herman G. Kreeftenberg, R. Arthur Bouwman, Albert H. M. van Straten, Wolfgang F. Buhre, Mohamed A. Soliman Hamad*

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

29 Citations (Web of Science)

Abstract

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 I 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. (C) 2017 Elsevier Inc. All rights reserved.

Original languageEnglish
Pages (from-to)45-53
Number of pages9
JournalJournal of Cardiothoracic and Vascular Anesthesia
Volume31
Issue number1
DOIs
Publication statusPublished - Feb 2017

Keywords

  • cardiac surgery
  • hyperlactatemia
  • mortality
  • survival analysis
  • outcomes
  • VENOUS OXYGEN-SATURATION
  • CRITICALLY-ILL PATIENTS
  • BLOOD LACTATE
  • SERUM LACTATE
  • BASE DEFICIT
  • CARDIOPULMONARY BYPASS
  • MORTALITY
  • HYPERLACTATEMIA

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