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Volume 3 Supplement 1

ESICM LIVES 2015

Serial arterial lactate levels as a predictor of short- and long-term mortality in patients after cardiac surgery

Introduction

Although hyperlactatemia is common after cardiac surgery (CS), its value and utility as a prognostic marker is controversial.

Objectives

The aim of the present study was to determine whether postoperative serial arterial lactate (AL) measurements after CS can predict outcome.

Methods

Prospective, observational study in our Surgical ICU in a tertiary-level university hospital. AL was measured on ICU admission,6,12 and 24h after CS, together with clinical data and outcomes including in-hospital and long-term mortality.

Results

2935 patients were included. In-hospital and long-term mortality (mean follow-up 6.3 ± 1.7 years) were 5.9% and 8.3% respectively.In comparison with survivors, non-survivors showed higher mean AL values in all measurements(P < 0.001). Hyperlactatemia(AL>3.0 mmol/L) was a predictor for both in-hospital mortality (OR:1.468;95% CI:1.239-1.739;P < 0.001) and long-term mortality(HR:1.511;95% CI:1.251-1.825;P < 0.001).Recent myocardial infarction and longer cardiopulmonary bypass time were predictors of hyperlactatemia. The pattern of AL dynamics was similar in both groups, but non-survivors presented higher AL values, as confirmed by repeated measures analysis of variance(P < 0.001). The area under the curve also showed higher levels of AL in non-survivors(80.9 ± 68.2vs.49.71 ± 25.8 mmol·L-1·h-1;P = 0.038).Patients with hyperlactatemia were divided according to their timing of peak arterial lactate,with higher mortality and worse survival in those in whom AL peaked at 24h compared with other groups(79.1%vs.86.7-89.2%;P = 0.03).

Conclusions

The dynamics of the postoperative AL curve in patients undergoing cardiac surgery suggests a similar mechanism of hyperlactatemia in both groups,albeit with a higher production or lower clearance of AL in non-survivors. The presence of a peak of hyperlactatemia at 24h is associated with higher in-hospital and long-term mortality in those patients.

References

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    Kogan A, Preisman S, Bar A, et al: The impact of hyperlactatemia on postoperative outcome after adult cardiac surgery. J Anesth. 2012, 26: 174-8. 10.1007/s00540-011-1287-0.

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    Maillet JM, Le Besnerais P, Cantoni M, et al: Frequency, risk factors, and outcome of hyperlactatemia after cardiac surgery. Chest. 2003, 123: 1361-6. 10.1378/chest.123.5.1361.

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    Ranucci M, De Toffol B, Isgrò G, et al: Hyperlactatemia during cardiopulmonary bypass: determinants and impact on postoperative outcome. Crit Care. 2006, 10: R167-10.1186/cc5113.

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    Lindsay AJ, Xu M, Sessler DI, et al: Lactate clearance time and concentration linked to morbidity and death in cardiac surgical patients. Ann Thorac Surg. 2013, 95: 486-92. 10.1016/j.athoracsur.2012.07.020.

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Author information

Correspondence to V Corral-Velez.

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Keywords

  • Myocardial Infarction
  • Cardiopulmonary Bypass
  • Prognostic Marker
  • Repeated Measure Analysis
  • Lactate Level