Prognostic Value of Serum Lactate Levels in Patients Undergoing Urgent Heart Transplant: A Subanalysis of the ASIS-TC Spanish Multicenter Study

Couto‐Mallón, David; González‐Vílchez, Francisco; Almenar‐Bonet, Luis; Díaz‐Molina, Beatriz; Segovia‐Cubero, Javier; González-Costello, José; Delgado-Jiménez, Juan; Castel-Lavilla, María A.; Crespo‐Leiro, María G.; Rangel‐Sousa, Diego; Martínez‐Sellés, Manuel; Juan-Áracil, Gregorio Rábago; De-la-Fuente-Galán, Luis; Blasco‐Peiró, Teresa; Hervás-Sotomayor, Daniela; Garrido-Bravo, Iris P.; Mirabet‐Pérez, Sónia; Muñiz, Javier; Barge‐Caballero, Eduardo

doi:10.1016/j.rec.2018.02.021

Cited by 9 publications

(6 citation statements)

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“…The anaerobic glycolysis is the process by which the normal pathway of glycolysis is routed to produce lactate and this metabolic waste product will accumulate over time [16]. Lactate accumulation occurs at times when energy is required in the absence of oxygen and the preoperative serum lactate levels is a strong independent predictor of worse outcomes in patients undergoing urgent heart transplantation on short-term mechanical circulatory support [17]. Nonetheless, for patients who underwent lung transplantation after EVLP their outcomes were good despite increased lactate during EVLP [16].…”

Section: Discussionmentioning

confidence: 99%

Subnormothermic Ex Vivo Lung Perfusion Temperature Improves Graft Preservation in Lung Transplantation

Arni

Maeyashiki

Çıtak

et al. 2021

Cells

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Normothermic machine perfusion is clinically used to assess the quality of marginal donor lungs. Although subnormothermic temperatures have proven beneficial for other solid organ transplants, subnormothermia-related benefits of ex vivo lung perfusion (EVLP) still need to be investigated. Material and Methods: In a rat model, we evaluated the effects of 28 °C temperature on 4-h EVLPs with subsequent left lung transplantation. The recipients were observed for 2 h postoperatively. Lung physiology data were recorded and metabolic parameters were assessed. Results: During the 4-h subnormothermic EVLP, the lung oxygenation was significantly higher (p < 0.001), pulmonary vascular resistance (PVR) lower and dynamic compliance (Cdyn) higher when compared to the 37 °C EVLP. During an end-of-EVLP stress test, we recorded significantly higher flow (p < 0.05), lower PVR (p < 0.05) and higher Cdyn (p < 0.01) in the 28 °C group when compared to the 37 °C group. After the left lung transplantation, Cdyn and oxygenation improved in the 28 °C group, which were comparable to the 37 °C group. Chemokines RANTES, MIP-3α, MIP-1α MCP-1 GRO/KC and pro-inflammatory mediators GM-CSF, G-CSF and TNFα were significantly lower after the 28 °C EVLP and remained low in the plasma of the recipient rats after transplantation. The lungs of the 28 °C group showed significantly lowered myeloperoxidase activity and lowered levels of TNFα and IL-1β. Conclusions: Compared to the normothermic perfusion, the 28 °C EVLP improved Cdyn and PVR and reduced both the release of pro-inflammatory cytokines and myeloperoxidase activity in lung tissue. These observations were also observed after the left lung transplantation in the subnormothermic group. The 28 °C EVLP significantly improved biochemical, physiological and inflammatory parameters in lung donors.

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Section: Discussionmentioning

confidence: 99%

Subnormothermic Ex Vivo Lung Perfusion Temperature Improves Graft Preservation in Lung Transplantation

Arni

Maeyashiki

Çıtak

et al. 2021

Cells

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“…Anaerobic metabolism is characterized by lactic acidosis resulting from the excess formation of lactate in the absence of oxygen. For patients undergoing urgent heart transplant on short-term mechanical circulatory support, it has been reported that the preoperative serum lactate levels are a strong independent predictor of worse outcomes [ 41 ], but the outcomes for patients who underwent lung transplantation after EVLP remained good despite increased lactate during EVLP [ 40 ]. An EVLP setting is characterised by a lack of compensatory mechanisms (i.e., from kidneys or liver) and decreased lactate levels or reduced glucose consumption may indicate aerobic glycolysis in the two 28 °C with or without PFCOC groups.…”

Section: Discussionmentioning

confidence: 99%

Perfluorocarbon-Based Oxygen Carriers and Subnormothermic Lung Machine Perfusion Decrease Production of Pro-Inflammatory Mediators

Arni

Çıtak

Maeyashiki

et al. 2021

Cells

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The quality of marginal donor lungs is clinically assessed with normothermic machine perfusion. Although subnormothermic temperature and perfluorocarbon-based oxygen carriers (PFCOC) have proven favourable for other organ transplants, their beneficial use for ex vivo lung perfusion (EVLP) still requires further investigation. In a rat model, we evaluated on a 4 h EVLP time the effects of PFCOC with either 28 °C or 37 °C perfusion temperatures. During EVLP at 28 °C with PFCOC, we recorded significantly lower lung pulmonary vascular resistance (PVR), higher dynamic compliance (Cdyn), significantly lower potassium and lactate levels, higher lung tissue ATP content, and significantly lower myeloperoxidase tissue activity when compared to the 37 °C EVLP with PFCOC. In the subnormothermic EVLP with or without PFCOC, the pro-inflammatory mediator TNFα, the cytokines IL-6 and IL-7, the chemokines MIP-3α, MIP-1α, MCP-1, GRO/KC as well as GM-CSF, G-CSF and the anti-inflammatory cytokines IL-4 and IL-10 were significantly lower. The 28 °C EVLP improved both Cdyn and PVR and decreased pro-inflammatory cytokines and pCO2 levels compared to the 37 °C EVLP. In addition, the 28 °C EVLP with PFCOC produced a significantly lower level of myeloperoxidase activity in lung tissue. Subnormothermic EVLP with PFCOC significantly improves lung donor physiology and ameliorates lung tissue biochemical and inflammatory parameters.

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“…Según el (19) estudio publicado por Donnino et al , al relacionar la mortalidad con los niveles de lactato en sangre arterial, 31,67% presentaron niveles elevados de lactato, encontrándose incrementado en la mayoría de los casos de muertes acaecidas (7,5%), sin embargo, no representó un riesgo significativo de muerte posterior a la cirugía cardiovascular (OR= 0,12; IC95% 0,03 -0,4), al igual que en nuestro estudio la asociación fue no significativa. Un estudio multicéntrico, sin embargo, halló que el lactato sérico preoperatorio es un fuerte predictor independiente de peores resultados, sobre todo la sobrevida, en pacientes que se someten a trasplantes cardíacos urgentes con asistencia mecánica (27) circulatoria a corto plazo .…”

Section: Discussionunclassified

Lactate as a predictor of mortality in cardiovascular surgery

Jiménez

Cazzola

Yokoyama

2019

Rev. virtual Soc. Parag. Med. Int

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Lactato como predictor de mortalidad en cirugía cardiovascularLactate as a predictor of mortality in cardiovascular surgery 1 1 RESUMEN Introducción: el lactato es el producto final del metabolismo anaerobio y una valiosa herramienta diagnóstica para la interpretación, estratificación y comprensión de diferentes procesos patológicos del paciente críticamente enfermo. Objetivo: determinar la asociación entre los niveles séricos de lactato y la mortalidad y estancia hospitalaria en pacientes post operados de cirugía cardiovascular. Metodología: estudio observacional retrospectivo con componentes analíticos. Se incluyeron pacientes con patología cardiovascular, mayores de 18 años, de ambos sexos, internados en el Hospital Nacional (Itauguá, Paraguay) entre los años 2016-2017. La variable independiente fue el lactato y las dependientes el estado al alta y la estancia hospitalaria. Resultados: se incluyeron a 31 pacientes, con edad media 54,5 años, 61,2% fue de sexo masculino, 74,2% presentó comorbilidades. Se constató 38,7% de complicaciones post quirúrgicas, 25,0% fue taponamiento cardiaco, 25,0% sangrado. Se constató 9,6% de fallecimientos postquirúrgicos. No se encontró asociación estadísticamente significativa entre los niveles elevados de lactato con la estancia hospitalaria prolongada ni con los fallecimientos. Conclusión: los niveles de lactato sérico postquirúrgico fueron elevados (93,6%). No se evidenció asociación entre lactato sérico con la estancia hospitalaria ni con los fallecimientos. ABSTRACTIntroduction: Lactate is the final product of anaerobic metabolism and a valuable diagnostic tool for the interpretation, stratification and understanding of different pathological processes of the critically ill patient. Objective: To determine the association between serum lactate levels and mortality and hospital stay in post-cardiovascular surgery patients. Methodology: Retrospective observational study with analytical components. Patients with cardiovascular pathology, over 18 years old, males and females, admitted to the National Hospital (Itauguá, Paraguay) between the years 2016-2017 were included. The independent variable was lactate and the dependent ones were state at discharge and hospital stay.

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Prognostic Value of Serum Lactate Levels in Patients Undergoing Urgent Heart Transplant: A Subanalysis of the ASIS-TC Spanish Multicenter Study

Abstract: Preoperative serum lactate is a strong independent predictor of worse outcomes in patients undergoing urgent heart transplant on short-term mechanical circulatory support.

Cited by 9 publications

References 14 publications

Subnormothermic Ex Vivo Lung Perfusion Temperature Improves Graft Preservation in Lung Transplantation

Subnormothermic Ex Vivo Lung Perfusion Temperature Improves Graft Preservation in Lung Transplantation

Perfluorocarbon-Based Oxygen Carriers and Subnormothermic Lung Machine Perfusion Decrease Production of Pro-Inflammatory Mediators

Lactate as a predictor of mortality in cardiovascular surgery

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