Postoperative Serum Lactate Levels for In-Hospital Mortality Prediction Among Heart Transplant Recipients

Abstract

Background:Hyperlactatemia is a common phenomenon following cardiac surgeries and is associated with prolonged ICU stay and higher morbidity and mortality rates, but such analyses have never focused on patients undergoing heart transplantation (HTX), in whom hyperlactatemia defined with the traditional threshold is observed in nearly every individual. The present study aimed to assess the prognostic value and clinical usefulness of postoperative serum lactate level measurements for in-hospital mortality prediction following HTX. Material/Methods:Forty-six consecutive patients who underwent HTX in the Department of Cardiovascular Surgery and Transplantology between 2010 and 2015 were enrolled into a retrospective analysis. Serum lactate level measurements within the first 48 h after HTX were obtained from arterial blood gas analyses, that were routinely conducted every 6 h. Lactate clearance was determined for each patient individually throughout 3 different time frames: the first 24-h (Lac clear 0-24) and second 24-h period (Lac clear 24-48), and the first 48 h after surgery (Lac clear 0-48). Results:The ICU admission serum lactate levels differed between the deceased and survivors (7.6 vs. 4.3 mmol/L; p=0.000). Among all tested postoperative lactate level measurements, only the measurement taken upon ICU admission predicted in-hospital mortality ]; p=0.024). The receiving operating characteristic (ROC) curve for in-hospital mortality was constructed for ICU admission measurement, with the optimal cut-off point estimated at 7.0 mmol/L. Conclusions:Serum lactate level measurement upon ICU admission can be used as a predictive parameter for in-hospital mortality among heart transplant recipients. Values greater than 7.0 mmol/L can predict in-hospital mortality with 90% accuracy.

Lactate promotes endothelial-to-mesenchymal transition via Snail1 lactylation after myocardial infarction

“…It is positively correlated with the prognosis and mortality of patients with heart failure (11,12). Previous clinical investigation showed that serum lactate levels in heart transplant recipient survivors are significantly lower than those in nonsurvivors, indicating that serum lactate level can be used as a biomarker to determine heart transplant recipient mortality (34). In accordance, Zymlinski et al (11) observed elevated lactate levels in acute heart failure patients, which is associated with damage to the myocardium, liver, and kidney and a higher mortality rate.…”

Anesthetic managements, morbidities and mortalities in retroperitoneal sarcoma patients experiencing perioperative massive blood transfusion

“…In the examination of mortality factors, the singular factor correlated with postoperative 60-day death was lactate levels. Elevated lactate levels have been consistently reported as a robust risk factor linked to increased mortality in patients experiencing septic shock, cardiac arrest, hemorrhagic shock, and major surgeries (36)(37)(38)(39). A lactate level of ≥2.5 mmol/L has been identified as the optimal threshold for predicting 28-day mortality in severe sepsis and septic shock patients (40).…”

Hypoxia-induced signaling in the cardiovascular system: pathogenesis and therapeutic targets

“…408 In the context of endstage cardiac events, specifically heart failure, the level of lactate in the serum is closely associated with the prognosis and mortality of heart failure patients or post-heart transplant recipients. 255,409,410 Furthermore, lactic acid was found to induce myofibroblast differentiation where HIF-2α in lung vascular endothelial cells could pathogenically upregulate SNAIL1/2 and subsequent EndoMT, contributing to vascular remodeling, obliterative pulmonary vascular lesions, pulmonary fibrosis and advancement of severe pulmonary hypertension. 411,412 In addition, EndoMT also plays a vital role in the development of various cardiovascular conditions, including myocardial infarction, atherosclerosis, cardiac fibrosis, and valvular diseases.…”