Prognostic value of peak lactate during cardiopulmonary bypass in adult cardiac surgeries: A retrospective cohort study

Abstract

Objective: Tissue hypoperfusion during cardiopulmonary bypass (CPB) affects cardiac surgical outcomes. Lactate, an end product of anaerobic glycolysis from oxygen deficit, is a marker of tissue hypoxia. In this study, we aimed to identify the prognostic value of blood lactate level during CPB in predicting outcomes in adults undergoing cardiac surgeries. Materials and Methods: We retrospectively reviewed the medical records of patients who underwent cardiac surgeries with CPB from January 2015 to December 2015. Data about the characteristics of patients, preoperative status, type of surgery, and intraoperative lactate levels were collected. The outcomes were in-hospital mortality and complications. The receiver operating characteristics (ROC) curves were used to assess the ability of peak lactate level during CPB in predicting in-hospital mortality. Results: A total of 97 patients, including 61 who underwent emergent or urgent surgery, were enrolled. The types of surgery included coronary artery bypass grafting (CABG, n = 52), valve surgery ( n = 27), combined surgery (CABG and valve surgery, n = 4), great vessel surgery (including aortic dissection, n = 9), and others ( n = 5). The median CPB time was 139 min (interquartile range = 120–175). The median initial lactate and peak lactate levels during CPB were 0.9 and 4.2 mmol/L, respectively. In-hospital mortality was 14.4%, which was significantly associated with age and peak lactate level in the multivariate logistic regression model. When the peak lactate level during CPB reached 7.25 mmol/L, in-hospital mortality could be predicted with an area under the ROC curve of 0.75 (95% confidence interval: 0.59–0.90; P = 0.003), with a sensitivity of 57% and specificity of 93%. Conclusion: Hyperlactatemia during CPB was associated with increased in-hospital mortality. Thus, early detection of such conditions and aggressive postoperative care are important.

Clinical evaluation of two adult oxygenator systems in terms of mortality and major adverse events

“…26,32 High peak lactate levels during CPB are also known to be associated with high mortality. 36 In our study, no statistically significant differences were found between the two patient groups in terms of MAEs or mortality. However, Group S had a greater need for ECMOs, longer ventilation times, and longer ICU stays.…”

Association of serum anion gap and risk of long‐term mortality in patients following coronary artery bypass grafting: A propensity score matching study

“…27 The stress response to surgery, the use of beta-adrenergic agonists, systemic inflammation reaction, and lactate load from blood transfusion all contribute to elevated lactate levels in patients undergoing cardiac surgery. 28,29 Besides, end-organ hypoperfusion is not uncommon after cardiac surgery which might be a resource of lactic acidosis. And lactic acidosis also increases whole blood viscosity and hematocrit, leading to exacerbate hypoperfusion.…”

“…Of note, the lactate and ketone ion levels contribute the most to elevation of AG 27 . The stress response to surgery, the use of beta‐adrenergic agonists, systemic inflammation reaction, and lactate load from blood transfusion all contribute to elevated lactate levels in patients undergoing cardiac surgery 28,29 . Besides, end‐organ hypoperfusion is not uncommon after cardiac surgery which might be a resource of lactic acidosis.…”

Impacto de los niveles máximos de lactato en cirugía cardíaca

“…En particular, niveles de lactato que no se normalizan se han asociado con una tasa de mortalidad postoperatoria de aproximadamente el 20 % (5)(6)(7)(8).…”

“…La tasa de mortalidad a nivel mundial de los pacientes con hiperlactatemia tras cirugía cardiaca está estimada en 14%, pero varía significativamente en distintos lugares del mundo, como 3.1% en Marruecos, 5.6% en Colombia, el 14.4% en Taiwán, y el 14.9% en Australia. Por tal motivo, es importante mantener actualizada la información en nuestro país para poder correlacionarla con la información a nivel global (7,9,10) (8,(11)(12)(13)(14).…”