Prediction of the Postoperative Outcome in Liver Resection Using Perioperative Serum Lactate Levels

Recknagel, Sebastian; Rademacher, Sebastian; Höhne, Claudia; Lederer, Andri; Lange, U; Herta, Toni; Seehofer, Daniel; Sucher, Robert; Scheuermann, Uwe

doi:10.3390/jcm12062100

Cited by 1 publication

(2 citation statements)

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“… 8 . Major resection was a strong predictor of elevated lactate POD1 and peak lactate 8 , and it seems that lactate at least partially represents the extent of liver resection 23 . Thus, lactate has a lower discriminatory and predictive potential for PHLF in major resections where lactate can be elevated due to the reduction of liver size as well as pending liver failure.…”

Section: Discussionmentioning

confidence: 96%

“…However, the applicability of lactate for predicting PHLF particularly in major hepatectomies bearing the highest risk of PHLF 22 remains relatively unexplored. Lactate levels seem to depend on the extent of liver resection 23 and the discriminatory potential of lactate measurements could consequently be overestimated in mixed cohorts of both major and minor resections. Moreover, lactate must be put into the context of established pre- and intraoperative clinical risk factors and other routine lab values to assess its additional value for risk prediction 22 , 24 .…”

Section: Introductionmentioning

confidence: 99%

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Comparing the accuracy of prediction models to detect clinically relevant post-hepatectomy liver failure early after major hepatectomy

Baumgartner,

Engstrand,

Rajala

et al. 2023

British Journal of Surgery

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Background Arterial lactate measurements were recently suggested as an early predictor of clinically relevant post-hepatectomy liver failure (PHLF). This needed to be evaluated in the subgroup of major hepatectomies only. Method This observational cohort study included consecutive elective major hepatectomies at Karolinska University Hospital from 2010 to 2018. Clinical risk factors for PHLF, perioperative arterial lactate measurements and routine lab values were included in uni- and multivariable regression analysis. Receiver operating characteristics and risk cut-offs were calculated. Results In total, 649 patients constituted the study cohort, of which 92 developed PHLF grade B/C according to the International Study Group of Liver Surgery (ISGLS). Lactate reached significantly higher intra- and postoperative levels in PHLF grades B and C compared to grade A or no liver failure (all P < 0.002). Lactate on postoperative day (POD) 1 was superior to earlier measurement time points in predicting PHLF B/C (AUC 0.75), but was outperformed by both clinical risk factors (AUC 0.81, P = 0.031) and bilirubin POD1 (AUC 0.83, P = 0.013). A multivariable logistic regression model including clinical risk factors and bilirubin POD1 had the highest AUC of 0.87 (P = 0.006), with 56.6% sensitivity and 94.7% specificity for PHLF grade B/C (cut-off ≥0.32). The model identified 46.7% of patients with 90-day mortality and had an equally good discriminatory potential for mortality as the established ISGLS criteria for PHLF grade B/C but could be applied already on POD1. Conclusion The potential of lactate to predict PHLF following major hepatectomy was inferior to a prediction model consisting of clinical risk factors and bilirubin on first post-operative day.

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Section: Discussionmentioning

confidence: 96%