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Frequency, risk factors, and outcome of hyperlactatemia after cardiac surgery
Jean-Michel Maillet1, Paul Le Besnerais, Manuel Cantoni
1Cardiovascular and Thoracic Surgery Intensive Care Unit, Centre Cardiologique du Nord, Saint-Denis, France.
Insights
Hyperlactatemia after cardiac surgery is common, with immediate hyperlactatemia (IHL) significantly increasing ICU mortality risk. Early lactate measurement can identify high-risk patients for better outcomes.
Area of Science:
- Cardiology
- Intensive Care Medicine
- Biochemistry
Background:
- Hyperlactatemia is a known complication following cardiac surgery.
- Understanding the different patterns and predictors of hyperlactatemia is crucial for patient management.
Purpose of the Study:
- To determine the frequencies, risk factors, and outcomes of no hyperlactatemia (NHL), immediate hyperlactatemia (IHL), and late hyperlactatemia (LHL) after cardiac surgery.
- To assess the predictive value of different hyperlactatemia patterns for ICU mortality.
Main Methods:
- Prospective, observational study of 325 patients undergoing cardiopulmonary bypass (CPB) for cardiac surgery.
- Lactate concentrations measured at ICU admission, 4 hours, 6-16 hours, and day 1 post-surgery.
- Comparison of mortality rates and risk factors across NHL, IHL, and LHL groups.
Main Results:
- Immediate hyperlactatemia (IHL) occurred in 20.6% and late hyperlactatemia (LHL) in 17.2% of patients.
- ICU mortality was significantly higher in the IHL group (14.9%) compared to LHL (3.6%) and NHL (1.5%).
- Independent risk factors for IHL included nonelective surgery and longer CPB duration; hyperglycemia and epinephrine therapy were risk factors for LHL.
Conclusions:
- Hyperlactatemia is a frequent occurrence post-cardiac surgery.
- A lactate threshold of 3 mmol/L at ICU admission effectively identifies patients at increased risk of morbidity and mortality.
Study Objective:
To determine the respective frequencies, risk factors, and outcomes of no hyperlactatemia (NHL), immediate hyperlactatemia (IHL), or late hyperlactatemia (LHL) > 3 mmol/L after cardiac surgery.
Design:
Prospective and observational study.
Setting:
Cardiac surgery ICU in a 130-bed private community nonteaching hospital.
Patients:
Consecutive patients (n = 325) undergoing cardiopulmonary bypass (CPB) for cardiac surgery.
Intervention:
None.
Measurements:
Arterial blood gas levels and lactate concentrations were measured at ICU admission, 4 h after surgery, between 6 h and 16 h after surgery, and on day 1.
Main Results:
Sixty-seven patients (20.6%) had an IHL on ICU admission, and 56 patients (17.2%) acquired LHL during their ICU stay. ICU mortality was 1.5% for NHL, 3.6% for LHL, and 14.9% for IHL groups (p < 0.0001). The three groups differed significantly for elective surgery, type of operation, CPB duration, intraoperative mean arterial pressure, and intraoperative and postoperative use of vasopressor. Independent risk factors for IHL were nonelective surgery, CPB duration, and intraoperative use of vasopressor. Logistic regression identified hyperglycemia and epinephrine therapy for LHL as postoperative risk factors. Receiver operating characteristic curves showed that IHL more accurately predicted ICU mortality than LHL.
Conclusions:
Hyperlactatemia is common after cardiac surgery. A lactate threshold of 3 mmol/L at ICU admission is able to identify a population at risk of morbidity and mortality after cardiac surgery.