Use of Postoperative Peak Arterial Lactate Level to Predict Outcome After Cardiac Surgery

Haanschoten, Marco C.; Kreeftenberg, Herman G.; Bouwman, R. Arthur; Straten, Albert H.M. van; Buhre, W.; Hamad, Mohamed A. Soliman

doi:10.1053/j.jvca.2016.04.017

Cited by 36 publications

(30 citation statements)

References 25 publications

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“…Studies have shown that the highest postoperative lactate level in cardiac surgery patients is an independent risk factor for early and late mortality. 11,17,18 However, in our study, no significant correlation was found between the highest lactate level and mortality. This unexpected result is probably due to the different patient profile in our study.…”

Section: The Plasma Lactate Level Is Traditionally Indicative Of Tisscontrasting

confidence: 81%

The Effect of Serum Lactate and Lactate Clearence on Mortality in Cardiac Surgery Patients

Patmano¹,

Bingol²,

Tercan³

et al. 2019

Turkiye Klinikleri J Cardiovasc Sci

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ardiopulmonary bypass (CPB) is widely preferred to maintain systemic perfusion and oxygenation during cardiac surgery. Tissue hypoperfusion due to circulatory failure during CPB may lead to an increase in lactate levels secondary to anaerobic metabolism. 1,2 Studies have shown that high lactate levels are associated with poor outcomes in many clinical conditions, including cardiac surgery. 3 Blood lactate levels are also

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Section: The Plasma Lactate Level Is Traditionally Indicative Of Tisscontrasting

confidence: 81%

The Effect of Serum Lactate and Lactate Clearence on Mortality in Cardiac Surgery Patients

Patmano¹,

Bingol²,

Tercan³

et al. 2019

Turkiye Klinikleri J Cardiovasc Sci

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“…To speak of, the peak of blood lactate is a very powerful indicator to predicts mortality. 20 – 22 In our study, Lac 24max has been shown to be an independent predictor of both short-term and long-term mortality and superior to Lac adm according to the comparison results of ROC. A retrospective study put forward that a score consists of lactate and the qSOFA perform better than the qSOFA alone in predicting mortality.…”

Section: Discussionmentioning

confidence: 50%

<p>Association of Different Lactate Indices with 30-Day and 180-Day Mortality in Patients with ST-Segment Elevation Myocardial Infarction Treated with Primary Percutaneous Coronary Intervention: A Retrospective Cohort Study</p>

Hu¹,

Lin²,

Xu³

et al. 2020

TCRM

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Background Admission lactate level has been reported as a useful marker of mortality. In this study, we compared the relative value of different lactate indices to predict survival in patients with ST-segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PCI). Methods This was a retrospective observational study including consecutive patients with STEMI undergoing primary PCI who admitted to the Coronary Care Unit of the First Affiliated Hospital of Wenzhou Medical University between 2014 and 2017. The predictive value of lactate indices for mortality was compared using receiver operator characteristic (ROC) analysis, and DeLong’s test was used to compare the AUC. We compared the AUC between GRACE score and GRACE score + lactate index. Results A total of 1080 patients were included. Fifty-nine died in 30 days and 68 died in 180 days. Most lactate indices (Lac adm , Lac 24max , Lac 24min and Lac 24tw ) were significantly lower in survivors (all P<0.001). In Cox proportional hazards model, each lactate index showed as an independent factor of 30-day and 180-day mortality except Lac Δ . Kaplan–Meier curves demonstrated that the patients of higher lactate indices group had higher rates of mortality (all P<0.0001, except Lac Δ P=0.0485). In receiver operator characteristic analysis, Lac 24max was significantly larger than Lac adm (P<0.001) while the AUC value for Lac adm was similar to Lac 24min and Lac 24tw . Lac 24tw improved the predictive probability of 30-day mortality (P=0.0415). Lac 24max improved the predictive probability of GRACE score for both 30-day and 180-day mortality (P<0.05). Conclusion In patients with STEMI undergoing primary PCI, most lactate indices are all associated with 30-day and 180-day mortality except LacΔ. In prediction of both 30-day and 180-day mortality, Lac 24max is superior to Lac adm and significantly enhances the ability of risk stratification and prognostic evaluation when adding Lac 24max to the GRACE score.

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“…These findings corroborate findings of the largest study on lactate production in cardiac surgical patients. 2 Haanschoten et al analyzed the highest lactate level within 3 postoperative days in nearly 8,000 patients. The investigators found that the 10 mmol/L, and >10 mmol/L had mortality rates of 3.7%, 20%, and 63%, respectively.…”

mentioning

confidence: 99%

Elevation of Intraoperative Lactate Levels During Cardiac Surgery: Is There Power in This Prognostication?

Cotter

Kidd

Flynn

2020

Journal of Cardiothoracic and Vascular Anesthesia

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Clinicians discovered and began using lactate as a biomarker in the mid-1800s. Yet, its utility as a clinical tool continues to vex modern-day physicians. Although an increasing amount of literature has shown that elevations in lactic acid are generally unfavorable, 1-4 the underlying etiology, how to treat, and how to prevent increases in lactate remain elusive. In this month's Journal of Cardiothoracic and Vascular Anesthesia, Govender et al. 5 used intraoperative lactic acid concentration as a dynamic variable to be assessed during cardiac surgery. Cardiopulmonary bypass (CPB) is arguably one of the most precarious interventions in medicine, as it calls for meticulous attention to fluid composition, appropriate delivery of oxygen, and acid-base balance. Unlike previous investigators, Govender, et al. analyzed the change in intraoperative lactate levels, independent of the initial value, and associations with adverse outcomes. Hyperlactatemia can result from anaerobic or aerobic pathways and occurs when there is excess production or decreased clearance of lactate. 6,7 It occurs in nearly two-thirds of patients undergoing cardiac surgery. 1 Lactic acidosis has been separated broadly into 2 types: A and B. Type A lactic acidosis accounts for most clinical presentations and results when oxygen delivery is insufficient, such as during hypovolemia, blood loss, sepsis, and cardiogenic shock. 7 Whether a global or regional oxygen debt exists, the hypoxic conditions result in anaerobic metabolism. In this scenario, a glycolytic pathway much less efficient than the citric acid cycle ensues with lactic acid produced as a byproduct. Alternatively, during aerobic conditions accelerated metabolism owing to stress or inotropic medications can overwhelm the pyruvate dehydrogenase enzyme, leaving pyruvate to be broken down into lactate instead of acetyl-coenzyme A. This is known as type B lactic acidosis. Type B lactic acidosis also can be caused by medications, malignancies, malnutrition, or congenital errors in metabolism, among others. 7 Furthermore, epinephrine, which commonly is used in cardiac surgery, increases hepatic degree of lactate rise directly correlated with 30-day mortality.

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Use of Postoperative Peak Arterial Lactate Level to Predict Outcome After Cardiac Surgery

Cited by 36 publications

References 25 publications

The Effect of Serum Lactate and Lactate Clearence on Mortality in Cardiac Surgery Patients

The Effect of Serum Lactate and Lactate Clearence on Mortality in Cardiac Surgery Patients

<p>Association of Different Lactate Indices with 30-Day and 180-Day Mortality in Patients with ST-Segment Elevation Myocardial Infarction Treated with Primary Percutaneous Coronary Intervention: A Retrospective Cohort Study</p>

Elevation of Intraoperative Lactate Levels During Cardiac Surgery: Is There Power in This Prognostication?

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