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

Wang, Su; Wang, Dashuai; Huang, Xintang; Wang, Hongfei; Shen, Le; Zhang, J; Du, Xiaona

doi:10.21037/jtd-21-1004

Cited by 3 publications

(2 citation statements)

References 51 publications

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“…Similar to other studies, 6,22,32–34 the multivariate analyses identified the STS score, logistic Euro SCORE II, durations of aortic cross-clamping, CPB, anaesthesia, and surgery, intraoperative myocardial ischemia, and cumulative intraoperative bleeding as predictors for hyperlactatemia. Additionally, similar to previous investigators, 14,17 several independent predictors for vasoplegia after CPB have been identified in the present study, including long durations of aortic cross-clamping and CPB, intraoperative episodes of hypotension and myocardial ischemia, and the need for PRBCs transfusion.…”

Section: Discussionsupporting

confidence: 90%

Effects of norepinephrine infusion during cardiopulmonary bypass on perioperative changes in lactic acid level (Norcal)

et al. 2022

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Introduction Hyperlactatemia, a problem reported in up to 30% of cardiac surgery patients, results from excessive production of or decreased clearance of lactate. It is typically a symptom of tissue hypoperfusion and may be associated with the prevalence of postoperative acute mesenteric ischemia and renal failure, or prolonged intensive care unit (ICU) and hospital stay, and increased 30-day mortality. Methods and measurements Eighty cardiac surgery patients using cardiopulmonary bypass (CPB) were randomly assigned into either a placebo (n = 39) or norepinephrine 0.05–0.2 µg/kg/min (n = 41) as well as norepinephrine boluses during CPB to maintain mean arterial blood pressure (MAP) at 65 to 80 mm Hg. Patient assignments were done after receiving ethical approval to proceed. The primary result was the perioperative changes in lactic acid level. Secondary findings were also recorded, including hemodynamic variables, the incidence of vasoplegia, intraoperative hypotension, myocardial ischemia, the need for vasopressor support, postoperative complications, and mortality. Results The peak levels and perioperative changes in blood lactate during the first 24 postoperative hours, the number of patients who experienced early hyperlactatemia on admission to the ICU (Placebo: 46.2%, Norepinephrine: 51.2%, p = .650), vasoplegia, hemodynamic changes, incidences of intraoperative hypotension, myocardial ischemia, postoperative complications, and mortality rates were similar in the two groups. Patients in the norepinephrine group received lower intraoperative rescue norepinephrine boluses to maintain the target MAP (p = .039) and had higher MAP values during the CPB and intraoperative blood loss [mean difference [95% confidence interval]; 177 [20.9–334.3] ml, p = .027]. Conclusion norepinephrine and placebo infusions during the CPB with the maintenance of MAP from 65 to 80 mmHg had comparative effects on the changes in blood lactate and incidence of vasoplegia after cardiac surgery. Norepinephrine infusion maintained higher MAP values during the CPB.

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Section: Discussionsupporting

confidence: 90%

Effects of norepinephrine infusion during cardiopulmonary bypass on perioperative changes in lactic acid level (Norcal)

et al. 2022

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“…Weiss and Rady et al reported that emergency surgery correlated significantly with time to extubation and lung injury, and was independent predictor of early postoperative pulmonary dysfunction ( 27 , 28 ). Previous studies have identified the close relationship between renal insufficiency and various postoperative complications after cardiovascular surgery, such as hypoxemia, pneumonia, hyperlactatemia, and tracheostomy ( 3 , 29 – 33 ). Although the related researches on the relationship between renal insufficiency and hypoxemia are limited and the exact mechanisms remain to be further investigated, we guess that inflammatory responses, erythropoietin production by the kidney, and the subsequent oxygen delivery may be involved ( 34 ).…”

Section: Discussionmentioning

confidence: 99%

Nomogram and risk calculator for severe hypoxemia after heart valve surgery

Ding

Cheng²,

Sun³

et al. 2022

Front. Cardiovasc. Med.

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BackgroundHypoxemia is a very common issue in patients undergoing heart valve surgery (HVS), related to poor clinical outcomes. However, studies on severe hypoxemia (SH) after HVS have not been reported. The aims of this study were to identify predictors for SH in patients undergoing HVS and to develop and validate a risk prediction model.MethodsPatients undergoing HVS between 2016 and 2019 in a cardiovascular center were enrolled and were assigned to training and validation sets by a 7:3 ratio. Based on whether patients developed SH, they were divided into two groups. By univariate and multivariate analysis, predictors for SH were identified. Based on the predictors and logistic rule, a nomogram and a risk calculator were generated. The model was evaluated using calibration, discrimination and clinical utility.ResultsThe incidence rates of SH, moderate hypoxemia and mild hypoxemia were respectively 2.4, 23.9, and 58.2%. By multivariate analysis, seven independent risk factors for SH after HVS were identified, including body mass index, chronic obstructive pulmonary disease, renal insufficiency, white blood cell count, serum globulin, cardiopulmonary bypass time, and surgical types. The logistic model demonstrated satisfactory discrimination, calibration and clinical utility in both the training and validation sets. A nomogram and a risk calculator based on the logistic model were generated for easy application. Risk stratification was performed and three risk intervals were defined according to the nomogram and clinical practice. In addition, compared to patients without SH, patients with SH had significantly poorer clinical outcomes.ConclusionsPostoperative hypoxemia was prevalent after HVS, related to poor clinical outcomes. A logistic model including seven independent predictors for SH after HVS were established and validated, which demonstrated satisfactory discrimination, calibration and clinical utility. The results of this study may provide help to individualized risk assessment, early prevention and perioperative management.

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Development and validation of a clinical prediction model for early ventilator weaning in post-cardiac surgery

Xie,

Wang,

Lin

et al. 2024

Heliyon

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

Cited by 3 publications

References 51 publications

Effects of norepinephrine infusion during cardiopulmonary bypass on perioperative changes in lactic acid level (Norcal)

Effects of norepinephrine infusion during cardiopulmonary bypass on perioperative changes in lactic acid level (Norcal)

Nomogram and risk calculator for severe hypoxemia after heart valve surgery

Development and validation of a clinical prediction model for early ventilator weaning in post-cardiac surgery

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