Lactato sérico como marcador de morbimortalidade no pós-operatório de operação de Jatene em lactentes

Rocha, Taís Sica da; Silveira, Alan Soares da; Botta, A; Ricachinevsky, Cláudia Pires; Mulle, Lisiane Dalle; Nogueira, Aldemir

doi:10.1590/s0102-76382010000300011

Cited by 14 publications

(6 citation statements)

References 30 publications

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“…Previous studies have shown a higher risk of mortality in younger children [1,31]. Lactate levels correlated with mortality in postoperative cardiac surgery children [32,33] as well as critically ill adult patients [34]. A low level of platelets correlated with mortality increase [35].…”

Section: Discussionmentioning

confidence: 99%

Pro-adrenomedullin, pro-endothelin-1, procalcitonin, C-reactive protein and mortality risk in critically ill children: a prospective study

et al. 2013

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IntroductionWe tested the hypothesis that higher mid-regional pro-adrenomedullin (MR-proADM), carboxy-terminal pro-endothelin-1 (CT-proET-1), procalcitonin (PCT) and C-reactive protein (CRP) plasma concentrations would be associated with increased prediction of mortality risk scores.MethodsProspective observational study set in two pediatric intensive care units (PICUs). Two-hundred-thirty-eight patients were included. MR-proADM, CT-proET-1, PCT and CRP levels were compared between children with PRISM III and PIM 2 > p75 (Group A; n = 33) and the rest (Group B; n = 205).ResultsMedian (range) MR-proADM levels were 1.39 nmol/L (0.52–12.67) in group A versus 0.54 (0.15–3.85) in group B (P < 0.001). CT-proET-1 levels were 172 pmol/L (27–500) versus 58 (4–447) (P < 0.001). PCT levels were 7.77 ng/mL (0.34–552.00) versus 0.28 (0.02–107.00) (P < 0.001). CRP levels were 6.23 mg/dL (0.08-28.25) versus 1.30 mg/dL (0.00-42.09) (P = 0.210). The area under the ROC curve (AUC) for the differentiation of group A and B was 0.87 (95% CI:0.81–0.821) for MR-proADM, 0.86 (95% CI:0.79–0.92) for CT-proET-1 and 0.84 (95% CI:0.74–0.94) for PCT. A MR-proADM > 0.79 nmol/L had 93% sensitivity and 76% specificity to differentiate groups, whereas a CT-proET-1 > 123 pmol/L had 77% sensitivity and 84% specificity, and a PCT concentration > 2.05 ng/mL had 80% sensitivity and specificity.ConclusionsIn critically ill children, high levels of MR-proADM, CT-proET-1 and PCT were associated with increased prediction of mortality risk scores. MR-proADM, CT-proET-1 and PCT concentrations higher than 0.80 nmol/L, 123 pmol/L and 2 ng/mL, respectively, could be used by clinicians to identify critically ill children at higher prediction of risk death scores.

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Section: Discussionmentioning

confidence: 99%

Pro-adrenomedullin, pro-endothelin-1, procalcitonin, C-reactive protein and mortality risk in critically ill children: a prospective study

et al. 2013

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“…Maluf et al21 studied patients with complex congenital heart disease, characterized by right ventricle hypoplasia, had a palliative surgical option with one and a half ventricular repair and claim that surgical treatment of the congenital cardiac anomalies in the presence of a hypoplastic right ventricle by means of one and a half ventricle repair has the advantages of reducing the surgical risk of biventricular repair compared to the Fontan circulation. da Rocha et al22 assessed the morbidity and mortality after Jatene's operation using lactate as the main marker and claim that morbidity and mortality can be assessed with the serum lactate levels, suggesting increased values in the third hour is suggestive of a worse prognosis. de Souza et al23 studied the mortality rate of children undergoing to Fontan operation and determined whether the hypoplastic left heart syndrome is not a risk factor for hospital mortality.…”

Section: Introductionmentioning

confidence: 99%

A survey of recently published cardiovascular, hematological and pneumological original articles in the Brazilian scientific press

Patel¹,

Caramelli²,

Gomes³

2011

Clinics

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Recent original scientific contributions published in selected Brazilian periodicals and classifiable under cardiovascular and pulmonary subject categories cover a wide range of sub specialties, both clinical and exprimental. Because they appear in journals with only recently enhanced visibility, we have decided to highlight a number of specific items appeared in four Brazilian journals, because we understand that this is an important subsidy to keep our readership adequately informed. These papers cover extensive sub-areas in both fields.

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“…They found that postextracorporeal cardiopulmonary resuscitation nonsurvivors had higher lactate level and lower clearance in the first 24 h. Rocha et al . [ 18 ] evaluated lactate trend in infants after Jatene's operation and found that increased serum lactate from the 3 rd h in the postoperative period can assess mortality. In our study, we found that early lactate clearance, as defined by the percentage of lactate cleared over the first 6-h in the postoperative period can predict in-hospital mortality in postcardiac surgery patients.…”

Section: Discussionmentioning

confidence: 99%

The role of blood lactate clearance as a predictor of mortality in children undergoing surgery for tetralogy of Fallot

et al. 2016

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Background:The identification of biomarkers for predicting morbidity and mortality, particularly in pediatric population undergoing cardiac surgery will contribute toward improving the patient outcome. There is an increasing body of literature establishing the clinical utility of hyperlactatemia and lactate clearance as prognostic indicator in adult cardiac surgical patients. However, the relationship between lactate clearance and mortality risk in the pediatric population remains to be established.Objective:To assess the role of lactate clearance in determining the outcome in children undergoing corrective surgery for tetralogy of Fallot (TOF).Methods and Study Design:A prospective, observational study.Setting:A tertiary care center.Study Population:Two hundred children undergoing elective surgery for TOF.Study Method:Blood lactate levels were obtained as baseline before operation (T0), postoperatively at admission to the cardiac intensive care unit after surgery (T1), and then at every 6 h for the first 24 h of Intensive Care Unit (ICU) stay (T6, T12, T18, and T24, respectively). The lactate clearance in the study is defined by the equation ([lactate initial – lactate delayed]/lactate initial) ×100%. Lactate clearance was determined at T1–T6, T1–T12, T1–T18, and T1–T24 time interval, respectively. The primary outcome measured was mortality. Secondary outcomes measured were the duration of mechanical ventilation, duration of inotropic requirement, and duration of ICU stay.Results:Eleven out of the two hundred patients enrolled in the study died. Nonsurvivors had higher postoperative lactate concentration (P < 0.05) and low-blood lactate clearance rate during 24 h (P < 0.05) in comparison to the survivors. Lactate clearance was significantly higher in survivors than in nonsurvivors for the T1–T6 period (19.55 ± 14.28 vs. 5.24 ± 27.79%, P = 0.009) and remained significantly higher for each studied interval in first 24 h. Multivariate logistic regression analysis of statistically significant univariate variables showed early lactate clearance to have a significant relationship with mortality. Patients with a lactate clearance >10%, relative to patients with a lactate clearance <10%, in the early postoperative period, had improved outcome and lower mortality.Conclusion:Lactate clearance in the early postoperative period (6 h) is associated with decreased mortality rate. Patients with higher lactate clearance (>10%) after 6 h have improved outcome compared with those with lower lactate clearance.

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Lactato sérico como marcador de morbimortalidade no pós-operatório de operação de Jatene em lactentes

Cited by 14 publications

References 30 publications

Pro-adrenomedullin, pro-endothelin-1, procalcitonin, C-reactive protein and mortality risk in critically ill children: a prospective study

Pro-adrenomedullin, pro-endothelin-1, procalcitonin, C-reactive protein and mortality risk in critically ill children: a prospective study

A survey of recently published cardiovascular, hematological and pneumological original articles in the Brazilian scientific press

The role of blood lactate clearance as a predictor of mortality in children undergoing surgery for tetralogy of Fallot

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