Evaluation of Increase in Intraoperative Lactate Level as a Predictor of Outcome in Adults After Cardiac Surgery

Govender, Pooveshni; Tosh, William; Burt, Christiana; Falter, Florian

doi:10.1053/j.jvca.2019.10.039

Cited by 25 publications

(18 citation statements)

References 33 publications

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“…Early-onset hyperlactatemia occurs during or soon after cardiopulmonary bypass (CPB) and late-onset hyperlactatemia develops within the first 12 hours after ICU admission (8). Some studies focused on identifying independent risk factors for POHL after cardiac surgery have been conducted and several predictors have been reported, such as elevated level of preoperative serum creatinine, longer CPB duration, higher blood glucose and reduced oxygen delivery (9,10). However, the physiological and clinical data suggested that lateonset hyperlactatemia was not attributed to impaired tissue perfusion or oxygen delivery, and the influencing factors may vary with time (11).…”

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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“…Hyperlactatemia usually occurs after cardiac surgery, which is related to poor prognosis [ 1 , 2 ] and is reported to be an independent risk factor for postoperative mortality in cardiac surgery patients [ 3 ]. Therefore, alleviating postoperative hyperlacticaemia is vitally important for improving the prognosis of cardiac patients [ 4 ].…”

Section: Introductionmentioning

confidence: 99%

Target blood pressure management during cardiopulmonary bypass improves lactate levels after cardiac surgery: a randomized controlled trial

et al. 2021

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Background Hyperlactatemia is associated with a poor prognosis in cardiac surgery patients. This study explored the impact of target blood pressure management during cardiopulmonary bypass (CPB) on blood lactate levels after cardiac surgery. Methods Adult patients undergoing cardiac valve surgery between 20/1/2020 and 30/6/2020 at Shanghai Chest Hospital were enrolled. The patients were randomized into a low mean arterial pressure (L-MAP) group (target MAP between 50 and 60 mmHg) or a high mean arterial pressure (H-MAP) group (target MAP between 70 and 80 mmHg), n = 20 for each. Norepinephrine was titrated only during CPB to maintain MAP at the target level. Blood lactate levels in the two groups were detected before the operation (T0), at the end of CPB (T1), at the end of the operation (T2), 1 h after the operation (T3), 6 h after the operation (T4) and 24 h after the operation (T5). The primary outcome was the blood lactate level at the end of the operation (T2). The secondary outcomes included the blood lactate level at T1, T3, T4, and T5 and the dose of epinephrine and dopamine within 24 h after the operation, time to extubation, length of stay in the ICU, incidence of readmission within 30 days, and mortality within 1 year. Results Forty patents were enrolled and analyzed in the study. The lactate level in the H-MAP group was significantly lower than that in the L-MAP group at the end of the operation (3.1 [IQR 2.1, 5.0] vs. 2.1 [IQR 1.7, 2.9], P = 0.008) and at the end of CPB and 1 hour after surgery. The dose of epinephrine within 24 h after the operation, time to extubation and length of stay in the ICU in the L-MAP group were significantly higher than those in the H-MAP group. Conclusions Maintaining a relatively higher MAP during CPB deceased the blood lactate level at the end of surgery, reduced epinephrine consumption, and shortened the time to extubation and length of stay in the ICU after surgery. Trial registration This single-center, prospective, RCT has completed the registration of the Chinese Clinical Trial Center at 8/1/2020 with the registration number ChiCTR2000028941. It was conducted from 20/1/2020 to 30/6/2020 as a single, blinded trial in Shanghai Chest Hospital.

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“…Blood lactate level can also predict the prognosis of cardiac surgery patients [3]. Therefore, alleviating the postoperative hyperlactacidemia acquires vital importance in improving the prognosis of cardiac patients [4].…”

Section: Introductionmentioning

confidence: 99%

Target blood pressure management during cardiopulmonary bypass improves lactate level after cardiac surgery: A randomized controlled trial

Miao

et al. 2021

Preprint

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Background：Hyperlactacidemia seriously affects the prognosis of cardiac surgery patients. This study was to explore the impact of target blood pressure management during cardiopulmonary bypass (CPB) on blood lactate level after cardiac surgery. Methods: Enrolled in this study were patients≧ 18 years who were scheduled for cardiac valve surgery between January 1, 2020 and June 30, 2020 at Shanghai Chest Hospital. The enrolled patients were randomized into a low mean arterial pressure (L-MAP) group (target MAP between 50-60mmHg) and a high mean arterial pressure (H-MAP) group (target MAP between 70-80 mmHg). Norepinephrine was titrated during CPB to maintain MAP at the target level.Blood lactate levels in the two groups were detect before operation (T0), at the end of CPB (T1), at the end of operation (T2), 1 h after operation (T3), 6 h after operation (T4) and 24 h after operation (T5) as the primary outcome. The secondary outcome was the dose of epinephrine and dopamine within 24 h after operation, at the time of extubation, during ICU stay, at the time of readmission within 30 days, and mortality in 1 year. Results: There was no significant difference in blood lactate level between the two groups at T0, T4 and T5. The lactate level in H-MAP group was significantly lower than that in L-MAP group (1.68±0.73, 2.33±0.93 and 2.90±1.09 mM;L-1 vs. 2.29±1.12, 3.63±1.86 and 4.60±2.24 mM;L-1) at T1, T2 and T3. The dose of epinephrine within 24 h after operation, at the time of extubation and during ICU stay in L-MAP group was significantly higher than that in H-MAP group. Conclusions: Target MAP management in patients with relatively high levels of MAP during CPB could decrease the blood lactate level, reduce epinephrine consumption, and shorten the time of extubation and length of ICU stay after surgery, thus improving the prognosis of cardiac surgery patients. Trial registration: This single-center single-blind RCT has completed the registration of the Chinese Clinical Trial Center with the registration number ChiCTR2000028941.

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Evaluation of Increase in Intraoperative Lactate Level as a Predictor of Outcome in Adults After Cardiac Surgery

Cited by 25 publications

References 33 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

Target blood pressure management during cardiopulmonary bypass improves lactate levels after cardiac surgery: a randomized controlled trial

Target blood pressure management during cardiopulmonary bypass improves lactate level after cardiac surgery: A randomized controlled trial

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