The usefulness of perioperative lactate blood levels in patients undergoing heart valve surgery

Duchnowski, Piotr; Hryniewiecki, Tomasz; Kuśmierczyk, Mariusz; Szymański, Piotr

doi:10.5114/kitp.2019.88599

Cited by 8 publications

(12 citation statements)

References 32 publications

(28 reference statements)

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“…Development and validation of a nomogram model for early postoperative hyperlactatemia in patients undergoing cardiac surgery (3)(4)(5)(6). The incidence of POHL differed considerably in the literature, with reported rates of 20.6-71.8% (4,5,7).…”

Section: Original Articlementioning

confidence: 99%

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

Wang

Huang

et al. 2021

J Thorac Dis

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Background:Postoperative hyperlactatemia (POHL) is common in patients undergoing cardiac surgery, associated with adverse outcomes. The aim of this study was to identify predictors for POHL after cardiac surgery and to develop and validate a predictive model. Methods:Adult patients who underwent open heart surgery at our institution between 2016 and 2019 were retrospectively included. The patients were randomly divided into training and validation groups at a 2:1 ratio. Multivariate logistic regression was performed to identify independent predictors for POHL in the training set. A nomogram was then constructed and was validated in the validation set. Results:POHL developed in 713 of the 5,323 patients (13.4%). The mortality rate was higher in patients with POHL compared with patients without that (9.5% vs. 2.1%, P<0.001). Age, white blood cell (WBC) count, left ventricular ejection fraction, renal insufficiency, cardiac surgery history, red blood cell (RBC) transfusion, and cardiopulmonary bypass (CPB) time were identified as independent risk factors. The nomogram based on these predictors indicated good discrimination in both the training (c-index: 0.787) and validation (c-index: 0.820) sets. The calibration was reasonable by both visual inspection and goodness-of-fit test. The decision and clinical impact curves demonstrated good clinical utility. Conclusions:We identified 7 independent risk factors and derived a prediction model for POHL in patients undergoing cardiac surgery. The model may contribute significantly to early risk assessment and clinical intervention.

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Section: Original Articlementioning

confidence: 99%

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

Wang

Huang

et al. 2021

J Thorac Dis

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“…Nevertheless, hyperlactatemia is still correlated with mortality in patients with septic shock and is a widely used prognostic marker [2]. Determination of serum lactate level may help assessment of hypoxia and lactic acidosis in patients with sepsis or septic shock [32]. More importantly, lactate levels should be measured in a timely manner; otherwise, it would be artificially elevated as red blood cell metabolism continues [3,31].…”

Section: Discussionmentioning

confidence: 99%

Red Cell Distribution Width as a Prognostic Factor and Its Comparison with Lactate in Patients with Sepsis

Wang

Hsu

2021

Diagnostics

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Sepsis remains the leading cause of death in critically ill patients. Thus, regular measurement of lactate levels has been proposed in sepsis guidelines. Elevated red cell distribution width (RDW) is associated with mortality risk in patients with sepsis. This study aimed to investigate the association between RDW and the risk of other adverse outcomes in patients with sepsis and to compare the mortality discriminative ability between lactate and RDW levels. This is a single-centered, retrospective, case-control study that included 504 adult patients with sepsis in the emergency department between 1 January 2020 and 31 December 2020. Eligible patients were divided into normal (RDW ≤ 14.5%) and high (RDW > 14.5%) groups. The baseline characteristics and adverse outcomes were recorded and compared. Compared with the normal RDW group, the patients in the high RDW group had a significantly higher rate of ICU admission (48.8% vs. 32.4%, p = 0.03), septic shock (39.2% vs. 23.5%, p < 0.01), and 30-day in-hospital mortality (32.0% vs. 20.7%, p < 0.01). Furthermore, the RDW (area under curve (AUC) = 0.71) had superior mortality discriminative ability compared to lactate (AUC = 0.63) levels (p = 0.02). Clinicians could rely on this simple and rapid parameter for risk stratification to initiate prompt treatment for patients with sepsis.

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“…The main cause of death in the early postoperative period in patients undergoing heart valve surgery is multiple organ dysfunction syndrome (MODS) [1]. The pathophysiological basis for postoperative MODS is cellular damage, which is manifested when cellular repair does not occur.…”

Section: Introductionmentioning

confidence: 99%

“…The pathophysiological basis for postoperative MODS is cellular damage, which is manifested when cellular repair does not occur. During operations the oxygen consumption is inadequate to meet intraoperative metabolic requirements [1]. Hypoxia may result from insufficient blood supply caused by decreased cardiac output, reduced hemoglobin levels, or impaired absorption of oxygen by target cells.…”

Section: Introductionmentioning

confidence: 99%

Sufentanil: a risk factor for lactic acidosis in patients after heart valve surgery

Zhan

Shi

Pan

et al. 2022

J Cardiothorac Surg

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Backgrounds Hyperlactatemia is a common metabolic disorder after cardiac surgery with cardiopulmonary bypass. Epinephrine use has been identified as a potential cause of increased lactate levels after cardiac surgery. Stress can lead to an increase in catecholamines, mainly epinephrine, in the body. Exogenous epinephrine causes hyperlactatemia, whereas endogenous epinephrine released by stress may have the same effect. Opioids are the most effective anesthetics to suppress the stress response in the body. The authors sought to provide evidence through a retrospective data analysis that helps investigate the relationship between intraoperative opioid dosage and postoperative lactic acidosis after cardiac surgery. Methods The clinical data of 215 patients who underwent valvular heart surgery with cardiopulmonary bypass from July 2016 to July 2019 were analyzed retrospectively. Blood lactate levels were measured at 0.1 h, 2 h, 4 h, and 8 h after surgery. Patients with continuous increases in lactate levels and lactate levels exceeding 5 mmol/L at two or more time points were included in the lactic acidosis group, whereas the other patients were included in the control group. First, univariate correlation analysis was used to identify parameters that were significantly different between the two groups, and then multivariate regression analysis was conducted to elucidate the independent risk factors for lactic acidosis. Fifty-one pairs of patients were screened by propensity score matching analysis (PSM). Then, lactic acid levels at four time points in both groups were analyzed by repeated measures ANOVA. Results he EF (heart ejection fraction) (OR = 0.94, P = 0.003), aortic occlusion time (OR = 10.17, P < 0.001) and relative infusion rate (OR = 2.23, P = 0.01) of sufentanil was an independent risk factor for lactic acidosis after valvular heart surgery. The patients were further divided into two groups with the mean sufentanil infusion rate as the reference point. The data were filtered with PSM (Propensity Score Matching). Lactic acid values in both groups peaked at 4 h after surgery and then declined. The rate of lactic acid decline was significantly faster in the group with a higher sufentanil dosage than in the lower group. The difference was statistically significant (P < 0.05). There was also a significant difference in lactic acid levels at the four time points (0.1 h, 2 h, 4 h and 8 h after surgery) in both groups (P < 0.001). Conclusion The inadequate intraoperative infusion rate of sufentanil is an independent risk factor for lactic acidosis after heart valve surgery. The possibility of lactic acidosis caused by this factor after cardiac surgery should be considered, which is helpful for postoperative patient management.

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The usefulness of perioperative lactate blood levels in patients undergoing heart valve surgery

Cited by 8 publications

References 32 publications

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

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

Red Cell Distribution Width as a Prognostic Factor and Its Comparison with Lactate in Patients with Sepsis

Sufentanil: a risk factor for lactic acidosis in patients after heart valve surgery

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