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 language | English |
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Pages (from-to) | 45-53 |
Number of pages | 9 |
Journal | Journal of Cardiothoracic and Vascular Anesthesia |
Volume | 31 |
Issue number | 1 |
DOIs | |
Publication status | Published - 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