Lactate, endothelin, and central venous oxygen saturation as predictors of mortality in patients with Tetralogy of Fallot

Abstract

Background:Lactate and central venous oxygen saturation (ScVO2) are well known biomarkers for adequacy of tissue oxygenation. Endothelin, an inflammatory marker has been associated with patient's nutritional status and degree of cyanosis. The aim of this study was to explore the hypothesis that lactate, ScVO2 and endothelin before induction may be predictive of mortality in pediatric cardiac surgery.Methods:We conducted a prospective observational study of 150 pediatric (6 months to 12 years) patients who were posted for intracardiac repair for tetralogy of fallot and measured lactate, ScVO2 and endothelin before induction (T1), 20 minutes after protamine administration (T2) and 24 hours after admission to ICU (T3).Results:Preinduction lactate and endothelin levels were found to predict mortality in patients of tetralogy of fallot with an odds ratio of 6.020 (95% CI 2.111-17.168) and 1.292(95% CI 1.091-1.531) respectively. In the ROC curve analysis for lactate at T1, the AUC was 0.713 (95% CI 0.526–0.899 P = 0.019). At the cutoff value of 1.750mmol/lt, the sensitivity and specificity for the prediction of mortality was 63.6% and 65.5%, respectively. For endothelin at T1, the AUC was 0.699 (95% CI 0.516–0.883, P = 0.028) and the cutoff value was ≤2.50 (sensitivity, 63.6%; specificity, 58.3 %). ScVO2 (odds ratio 0.85) at all three time intervals, suggested that improving ScVO2 can lead to 15% reduction in mortality.Conclusions:Lactate, ScVO2 and endothelin all showed association with mortality with lactate having the maximum prediction. Lactate was found to be an independent, reliable and cost-effective measure of prediction of mortality in patients with tetralogy of fallot.

Factors associated with perioperative mortality in children and adolescents operated for tetralogy of Fallot: A sub‐Saharan experience

“…In our series, 8 of 62 (12.9%) patients died during the perioperative period. This is higher than reported in many studies from the developed world, which report on younger patient populations and have more advanced perioperative facilities. As a surgical intervention for CHDs including TOF is not readily available in most sub‐Saharan countries, few studies exist against which we can compare our results.…”

High positive end expiratory pressure levels affect hemodynamics in elderly patients with hypertension admitted to the intensive care unit: a prospective cohort study

“…To control for confounding factors such as hemoglobin, arterial oxygen saturation and oxygen demand, we found that the correlation between PEEP and HR and ScvO 2 still existed. This indicated that elevated levels of PEEP caused decreased cardiac output in elderly hypertensive patients [18].…”

“…However, accurate measurement of cardiac output, such as by SwanGanz catheter and cardiac color ultrasound requires advanced instrumentation and incurs greater cost [31]. Recent studies have found that ScvO 2 can be used to evaluate the condition of left cardiac ejection, which is simple and reliable and can be used in clinical application [18]. A study by Lanspa et al reported that assessment of cardiac function often relied on ScvO 2 , with higher ScvO 2 corresponding with increased cardiac output [32].…”

A Systematic Review and Meta-Analysis of Intraoperative Goal Directed Fluid and Haemodynamic Therapy in Children and Postoperative Outcome

“…III.1°) Mortality (Supplemental Figure 12): three studies with 828 children in cardiac surgery evaluated this outcome using lactate levels and ScVO2. In one study mortality was higher in the experimental group and in the two other studies mortality was higher in the control groups [23,31,32]. Taking the three studies together there was no difference between the experimental and the control groups in terms of mortality (OR=0.02 [0.00, 17.18], p=0.25).…”

“…The quality of evidence (GRADE) was very low (three studies included and evaluated this outcome among the eight and high risk of bias). II°) Perioperative lactate levels: 9 studies in cardiac surgery were included for meta-analysis (6 observational prospective and 3 observational retrospective) [19][20][21][22][23][24][30][31][32]. II.1°) Mortality (Supplemental Figure 7): 9 trials (6 prospective and 3 retrospective) with 1690 children in cardiac surgery were included for this outcome.…”