High lactate levels are predictors of major complications after cardiac surgery

Abstract

Hyperlactatemia 6 hours after ICU admission is an independent risk factor for worse outcomes in adult patients after cardiac surgery.

Predicting cardiac surgery–associated acute kidney injury: The CRATE score

“…The variables used in CRATE (ICU-Creatinine, ICU-lactic Acid, cardiopulmonary bypass Time, and EuroSCORE 1) have been previously identified in different studies as predictors of AKI in cardiac surgery context. Hyperlactatemia (HL), a well-recognized marker of hypoperfusion, has been associated with organ dysfunction and poor outcome in various clinical settings, including cardiac surgery [18,19]. Up to 20% of patients develop HL during or shortly after CPB, and it frequently persists during the first hours of admission in ICU [18].…”

“…The latter is due to the effect of anesthetics in cellular metabolism and low core temperature during CPB. The use of catecholamines has also been related to HL due to changes induced in oxidative glucose metabolism [19]. Patients with HL during CPB are suffering from a sort of masked circulatory shock, which will exert its deleterious effects on different organs (mainly on renal function) during the early phases of the postoperative course [18].…”

“…Patients with HL during CPB are suffering from a sort of masked circulatory shock, which will exert its deleterious effects on different organs (mainly on renal function) during the early phases of the postoperative course [18]. In addition, increased levels of blood lactate have been associated with increased risk of morbidity and mortality and higher incidence of complications including AKI [19].…”

Blood Lactate Level as Predictor of Early Outcome after Cardiac Surgery under Cardiopulmonary Bypass

“…Rao et al (2001) and Arnold et al (2009) stated that the development of postoperative LOS and cardiovascular complications in the absence of an intraoperative misadventure revealed a failure of myocardial protection causing persistent anaerobic metabolism and lactate release. 8,10 In our study we evaluate the outcome variables for major adverse outcome and found neurological deficit, pulmonary complication and renal dysfunction have statistically significant differences between groups, Nichol et al (2010) showed a strong positive correlation between blood lactate levels and the risk of morbidity and mortality with neurological deficits.11 Hajjar et al (2013), Malliet et al (2003) and Ranucci et al (2006) showed in their studies a strong correlation between high lactate and major complications after cardiac surgery that are similar with current study. 4,5,9 In our study, binary logistic regression analysis shows that blood lactate level 6 hours after ICU transfer is an independent predictor for prolonged mechanical ventilation time, prolonged ICU stay, neurological deficit, pulmonary complication, arrhythmia, renal dysfunction and mortality.…”

“…8,10 In our study we evaluate the outcome variables for major adverse outcome and found neurological deficit, pulmonary complication and renal dysfunction have statistically significant differences between groups, Nichol et al (2010) showed a strong positive correlation between blood lactate levels and the risk of morbidity and mortality with neurological deficits.11 Hajjar et al (2013), Malliet et al (2003) and Ranucci et al (2006) showed in their studies a strong correlation between high lactate and major complications after cardiac surgery that are similar with current study. 4,5,9 In our study, binary logistic regression analysis shows that blood lactate level 6 hours after ICU transfer is an independent predictor for prolonged mechanical ventilation time, prolonged ICU stay, neurological deficit, pulmonary complication, arrhythmia, renal dysfunction and mortality. The results of this study and discussion thereof prompt us to recommend that routine lactate level measurement is essential for postoperative cardiac ICU to detect early adverse outcome.…”