Affiliation:
1. Nippon Medical School Musashi Kosugi Hospital
2. Nippon Medical School
3. Urasoe General Hospital
4. keiyu Hospital
Abstract
Abstract
BACKGROUND The relationship between intraoperative lactate levels and prognosis after emergency gastrointestinal (GI) surgery remains unclear. The purpose of this study was to investigate the prognostic value of intraoperative lactate levels for predicting in-hospital mortality, and to examine intraoperative hemodynamic managements.METHODS. We conducted a retrospective observational study of emergency GI surgeries performed at our institution between 2011 and 2020. The study group comprised patients admitted to intensive care units postoperatively, and whose intraoperative and postoperative lactate levels were available. Intraoperative peak lactate levels (Intra-LACs) were selected for analysis, and in-hospital mortality was set as the primary outcome. The prognostic value of intra-LAC was assessed using logistic regression and receiver operating characteristic (ROC) curve analysis.RESULTS. Of the 551 patients included in the study, 120 died postoperatively. Intra-LAC in the group who survived and the group who died was 1.56 [interquartile range [IQR], 1.03–2.64] mmol/L and 3.46 [IQR, 1.84–6.26] mmol/L (P < 0.001), respectively. The patients who died had larger volumes of red blood cell (RBC) transfusions and fluid administration, and were administered higher doses of vasoactive drugs. Logistic regression analysis showed that intra-LAC was an independent predictor of postoperative mortality (odds ratio [OR] 1.21, 95% CI 1.07–1.36, P = 0.002). The volume of RBCs, or fluids transfused, or the amount of vasoactive agents administered were not independent predictors. The area under the curve (AUC) of the ROC curve for intra-LAC for in-hospital mortality was 0.762 (95% confidence interval [CI], 0.71–0.81), with a cutoff value of 3.68 mmol/L by Youden index.CONCLUSIONS. The intraoperative lactate level but not hemodynamic managements was an independently associated with increased in-hospital mortality after emergency GI surgery.
Publisher
Research Square Platform LLC
Reference30 articles.
1. Lactic acidosis;Kraut JA;N Engl J Med,2015
2. Saugel B, Trepte CJ, Heckel K, Wagner JY, Reuter DA. Hemodynamic management of septic shock: is it time for "individualized goal-directed hemodynamic therapy" and for specifically targeting the microcirculation? Shock 2015, 43:522–9.
3. Lactate measurements in sepsis-induced tissue hypoperfusion: results from the Surviving Sepsis Campaign database;Casserly B;Crit Care Med,2015
4. Serum lactate is an independent predictor of hospital mortality in critically ill patients in the emergency department: a retrospective study;Bou Chebl R;Scand J Trauma Resusc Emerg Med,2017
5. High lactate levels are predictors of major complications after cardiac surgery;Hajjar LA;J Thorac Cardiovasc Surg,2013