Serum lactate level as a useful predictor of clinical outcome after surgery: an unfulfilled potential?

Cobianchi, Lorenzo; Peloso, Andréa; Filisetti, Claudia; Mojoli, Francesco; Sciutti, Fabio

doi:10.21037/jtd.2016.03.61

Cited by 17 publications

(6 citation statements)

References 16 publications

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“…Consistent with studies by Velickovic et al, Cobianchi et al and Bakker et al [ 8 , 14 , 15 ], it was observed that elevated serum lactate was significantly associated with surgical site infection with an aOR 1.25 95%CI 1.11–3.72, p-value 0.008. Elevated serum lactate had a sensitivity of 94.4%, specificity of 54.3% and the accuracy of predicting SSI being sufficient at 0.6432 AUROC.…”

Section: Discussionsupporting

confidence: 89%

Elevated serum lactate as a predictor of outcomes in patients following major abdominal surgery at a tertiary hospital in Uganda

et al. 2021

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Introduction Major abdominal surgery is still a great contributor to postoperative morbidity and mortality in developing countries. Major abdominal surgery leads to hypoperfusion, which has an impact on postoperative morbidity and mortality. Lactate, a biomarker for hypoperfusion is under utilized in Uganda. The study aimed to investigate the association between elevated serum lactate and outcomes (in-hospital mortality, SSI and length of hospital stay) in patients following major abdominal surgery. Methods A prospective observational cohort study was done with 246 eligible patients recruited. Stratified sampling was carried out till desired sample size was achieved. Demographic and perioperative data were collected, serum lactate levels were measured at induction and immediately after surgery with serial measurements being done after 12, 24 h post operatively. Participants were followed up to assess outcomes. Data analysis was done using STATA version 14.0. Results A total of 130 patients (52.8%) had elevated serum lactate levels. Elevated serum lactate predicted in-hospital mortality and surgical site infection. The accuracy of elevated serum lactate to predict mortality with AUROC of 0.7898 was exhibited by the 24 h lactate values. Elevated serum lactate predicted surgical site infection accurately with AUROC 0.6432. Length of hospital is strongly associated with elevated serum lactate with p-value of 0.043. Patients with elevated serum lactate on average have a longer length of hospital stay at 5.34 ± 0.69. Conclusion Elevated serum lactate was associated with in-hospital mortality, surgical site infection and longer length of hospital stay. Serum lactate levels done at 24 h were most predictive of mortality and surgical site infection.

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Section: Discussionsupporting

confidence: 89%

Elevated serum lactate as a predictor of outcomes in patients following major abdominal surgery at a tertiary hospital in Uganda

et al. 2021

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“…The association between CPB duration and early-onset or lateonset hyperlactatemia has been verified by some published studies, however, some other studies yielded different results (19)(20)(21). The occurrence of POHL after cardiac surgery may be caused by a mixture of early-and late-onset hyperlactatemia mechanisms and the change of the lactate levels was related to the physiopathologic mechanisms and the efficacy of the treatment (22). Lactate-guided therapy on patients with POHL at ICU arrival can significantly decrease the hospital mortality, and intervention at an early stage (before or during surgery) may be more valuable to reduce risk (23).…”

Section: Discussionmentioning

confidence: 87%

Development and validation of a nomogram model for early postoperative hyperlactatemia in patients undergoing cardiac surgery

Wang

Huang

et al. 2021

J Thorac Dis

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Background:Postoperative hyperlactatemia (POHL) is common in patients undergoing cardiac surgery, associated with adverse outcomes. The aim of this study was to identify predictors for POHL after cardiac surgery and to develop and validate a predictive model. Methods:Adult patients who underwent open heart surgery at our institution between 2016 and 2019 were retrospectively included. The patients were randomly divided into training and validation groups at a 2:1 ratio. Multivariate logistic regression was performed to identify independent predictors for POHL in the training set. A nomogram was then constructed and was validated in the validation set. Results:POHL developed in 713 of the 5,323 patients (13.4%). The mortality rate was higher in patients with POHL compared with patients without that (9.5% vs. 2.1%, P<0.001). Age, white blood cell (WBC) count, left ventricular ejection fraction, renal insufficiency, cardiac surgery history, red blood cell (RBC) transfusion, and cardiopulmonary bypass (CPB) time were identified as independent risk factors. The nomogram based on these predictors indicated good discrimination in both the training (c-index: 0.787) and validation (c-index: 0.820) sets. The calibration was reasonable by both visual inspection and goodness-of-fit test. The decision and clinical impact curves demonstrated good clinical utility. Conclusions:We identified 7 independent risk factors and derived a prediction model for POHL in patients undergoing cardiac surgery. The model may contribute significantly to early risk assessment and clinical intervention.

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“…Lactate is a reliable sepsis marker as an important indicator of tissue hypoxia and has been shown in many other studies where it can predict poor outcomes. 15,16 In cancer patients, tumor cells convert glucose to lactate in an aerobic environment with the "Warburg effect". 17 This feature for the protection of redox balance in proliferating cells may explain the relationship between the increased tumor stage and lactate, which is another significant result of our study.…”

Section: Discussionmentioning

confidence: 99%

Factors affecting a persistent increase in the perioperative lactate levels in colorectal cancer surgery and its impact on postoperative outcomes

Gülmez

Uzun

Senger

et al. 2020

APIC

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Serum lactate level as a useful predictor of clinical outcome after surgery: an unfulfilled potential?

Cited by 17 publications

References 16 publications

Elevated serum lactate as a predictor of outcomes in patients following major abdominal surgery at a tertiary hospital in Uganda

Elevated serum lactate as a predictor of outcomes in patients following major abdominal surgery at a tertiary hospital in Uganda

Development and validation of a nomogram model for early postoperative hyperlactatemia in patients undergoing cardiac surgery

Factors affecting a persistent increase in the perioperative lactate levels in colorectal cancer surgery and its impact on postoperative outcomes

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