Elevated Lactate is Independently Associated with Adverse Outcomes Following Hepatectomy

Lemke, Madeline; Karanicolas, Paul J.; Habashi, Rogeh; Behman, Ramy; Coburn, Natalie; Hanna, Sherif S.; Law, Calvin; Hallet, Julie

doi:10.1007/s00268-017-4118-0

Cited by 25 publications

(27 citation statements)

References 46 publications

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“…Lactate and LCR are widely regarded as prognostic indexes for shock patients [2,4,12,13]. Although in this study, both lactate (T 1 , T 2 ) and LCR(T 0 − 1 ) still have their significances, compared to PPI, which could be used to predict outcomes in the first hour in ICU, their shortcomings are obvious, not to mention that they're invasive and not real-time.…”

Section: Roc Analysesmentioning

confidence: 80%

“…Many patients undergoing long time surgery will manifest increased level of blood lactate [1][2][3].…”

Section: Backgroundsmentioning

confidence: 99%

“…Hyperlactacidemia can cause disturbance of internal environment, then leading to increased complications and longer ICU stay, even death [1,2,4,5]. For postoperative patients, we must ensure adequate perfusion in order to minimize the length of hyperglycemia and improve patients' outcomes.…”

Section: Backgroundsmentioning

confidence: 99%

“…In regard to surgical patients, especially who are transferred to ICU after surgeries, going through big operations is a challenge. On top of that, they are at risk of increased blood lactate [1][2][3]. So, it is essential to ensure adequate perfusion to accelerate lactate clearance and shorten the length of hyperlactacidemia.…”

Section: Roc Analysesmentioning

confidence: 99%

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Peripheral perfusion index predicting early hypoperfusion, reflecting lactate clearance rate and length of ICU stay in surgical patients: an observational study

Shi¹,

Xu²,

Yu³

et al. 2020

Preprint

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BackgroundPeripheral perfusion index (PPI) is associated with hypoperfusion in critical patients. Many researches focus on using PPI as a predictor in septic shock, but few studies report on its significance in surgical patients. We performed this study to find out association between PPI and surgical patients' prognoses. MethodsIt's a retrospective study from January to June 2019, on surgical patients transferred to ICU, Xinyang Central hospital, Henan province, China. The inclusive/exclusive criteria are followings, inclusive:1) age ≥18 years old; 2) surgical length ≥120min; Exclusive: 1) died in ICU; 2) discharging against medical advice; 3) existing diseases affecting blood flow of upper limbs, for example, vascular thrombus in arms; 4) severe liver dysfunction Patients were grouped according to their length of ICU stay (LOS ICU, >48h regarded as prolonged ICU stay, otherwise non-prolonged). Baseline characteristics (age, gender, comorbidity), surgical sites and length, SOFA and APACHE II on 1st day in ICU, LOS ICU, mean artery pressure (MAP), lactate clearance rate (LCR), peripheral perfusion index (PPI), temperature (axillary) were collected and compared between the 2 groups. Correlation and ROC (receiver operating characteristic) analysis was also performed. ResultsEventually, 72 patients were included, 30 in prolonged and 42 in non-prolonged group. Compared to non-prolong, patients in prolonged ICU stay group had higher lactate(6h: 3.70±0.52 vs 2.50±0.59 mmol/L, p<0.001; 12h: 2.78±0.50 vs 1.90±0.30 mmol/L, p<0.001), lower LCR(0-6h: -20%[-37%, 0%] vs 19%[9%, 31%], p<0.001) and PPI (0h: 0.80± 0.27 vs 1.47±0.43, p<0.001; 6h: 0.88±0.25 vs 1.57±0.40, p<0.001). No difference was found in gender, age, surgical length, SOFA, APACHE II, temperature and comorbidity. Averaged 1h and 6h PPI were strongly associated with LCR (0-6h, correlation coefficient 0.5521h and 0.4366h) and LOS ICU(correlation coefficient: -0.6391h and -0.5606h). The area under the receiver operating characteristic (AUC) of PPIT0 and PPIT1 for predicting prolonged ICU stay were 0.905 and 0.916 respectively. The cutoff values of PPIT0 and

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Section: Roc Analysesmentioning

confidence: 80%

“…Many patients undergoing long time surgery will manifest increased level of blood lactate [1][2][3].…”

Section: Backgroundsmentioning

confidence: 99%

Section: Backgroundsmentioning

confidence: 99%

Section: Roc Analysesmentioning

confidence: 99%

See 2 more Smart Citations

Peripheral perfusion index predicting early hypoperfusion, reflecting lactate clearance rate and length of ICU stay in surgical patients: an observational study

Shi¹,

Xu²,

Yu³

et al. 2020

Preprint

View full text Add to dashboard Cite

show abstract

“…Hemodynamic changes in postoperative patients are complex and various. Many patients would manifest increased level of blood lactate after long-term surgeries [1][2][3]. Ensuring adequate perfusion is essential for recovery and better prognosis.…”

Section: Introductionmentioning

confidence: 99%

Peripheral perfusion index predicting prolonged ICU stay earlier and better than lactate in surgical patients: an observational study

Shi

et al. 2020

BMC Anesthesiol

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Background: Peripheral perfusion index (PPI) is an indicator reflecting perfusion. Patients undergoing long time surgeries are more prone to hypoperfusion and increased lactate. Few studies focusing on investigating the association between PPI and surgical patients' prognoses. We performed this study to find it out. Methods: From January 2019 to September 2019, we retrospected all surgical patients who were transferred to ICU, Xinyang Central hospital, Henan province, China. Inclusive criteria: age ≥ 18 years old; surgical length ≥ 120 min. Exclusive criteria: died in ICU; discharging against medical advice; existing diseases affecting blood flow of upper limbs, for example, vascular thrombus in arms; severe liver dysfunction. We defined "prolonged ICU stay" as patients with their length of ICU stay longer than 48 h. According to the definition, patients were divided into two groups: "prolonged group" (PG) and "non-prolong group" (nPG). Baseline characteristics, surgical and therapeutic information, ICU LOS, SOFA and APACHE II were collected. Besides we gathered data of following parameters at 3 time points (T0: ICU admission; T1: 6 h after admission; T2: 12 h after admission): mean artery pressure (MAP), lactate, heart rate (HR), PPI and body temperature. Data were compared between the 2 groups. Multivariable binary logistic regression and ROC (receiver operating characteristic) curves were performed to find the association between perfusion indictors and ICU LOS. Results: Eventually, 168 patients were included, 65 in PG and 103 in nPG. Compared to nPG, patients in PG had higher blood lactate and lower PPI. PPI showed significant difference between two groups earlier than lactate (T 0 vs T 1). The value of PPI at two time points was lower in PG than nPG(T0: 1.09 ± 0.33 vs 1.41 ± 0.45, p = 0.001; T1: 1.08 ± 0.37 vs 1.49 ± 0.41, p < 0.001). Increased lactate T1 (OR 3.216; 95% CI 1.253-8.254, P = 0.015) and decreased PPI T1 (OR 0.070; 95% CI 0.016-0.307, P < 0.001) were independently associated with prolonged ICU stay. The area under ROC of the PPI T1 for predicting ICU stay> 48 h was 0.772, and the cutoff value for PPI T1 was 1.35, with 83.3% sensitivity and 73.8% specificity. Conclusions: PPI and blood lactate at T 1 (6 h after ICU admission) are associated with ICU LOS in surgical patient. Compared to lactate, PPI indicates hypoperfusion earlier and more accurate in predicting prolonged ICU stay.

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Systematic review on peri‐operative lactate measurements to predict outcomes in patients undergoing liver resection

Connolly

Stättner

Niederwieser

et al. 2020

J Hepato Biliary Pancreat

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Lactate measurements have proven utility as a triage tool, therapeutic guide, and prognostic indicator, with broad use in Acute Care and transplantation. Its value in guiding therapy and predicting outcomes following liver resection is less well‐defined. This systematic review in accordance with Preferred Reporting Items for Systematic Reviews and Meta‐Analyses guidelines assessed the relationship between peri‐operative lactate levels and morbidity and mortality after liver resection. Seven relevant studies comprising 2573 patients in total were identified. Six studies assessed intra‐operative or early postoperative lactate levels, one publication examined pre‐operative levels. All studies demonstrated a significant association between peri‐operative lactate levels and adverse outcomes. The influence of pre‐operative diabetes and cirrhosis on postoperative lactate levels was shown in one study each, no study assessed the association of lactate with post‐hepatectomy liver failure according to defined criteria. The heterogeneity of study measurements and end‐points precluded a meta‐analysis from being performed. Early postoperative lactate >3‐3.7 mmol/L is associated with mortality but validation of clear cut‐off levels for outcome prediction is pending. Literature suggests lactate is a useful predictive marker for outcomes post liver surgery, especially when measured in the early postoperative phase. Further research is required to standardize the use of lactate measurements in a meaningful therapeutic manner.

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Elevated Lactate is Independently Associated with Adverse Outcomes Following Hepatectomy

Abstract: Patients with elevated PHL in the initial postoperative period should be carefully monitored due to increased risk of major morbidity and mortality. Further research on the impact of lactate-directed fluid therapy is warranted.

Cited by 25 publications

References 46 publications

Peripheral perfusion index predicting early hypoperfusion, reflecting lactate clearance rate and length of ICU stay in surgical patients: an observational study

Peripheral perfusion index predicting early hypoperfusion, reflecting lactate clearance rate and length of ICU stay in surgical patients: an observational study

Peripheral perfusion index predicting prolonged ICU stay earlier and better than lactate in surgical patients: an observational study

Systematic review on peri‐operative lactate measurements to predict outcomes in patients undergoing liver resection

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