The role of early postoperative lactate dynamics in predicting acute kidney injury and mortality after HIPEC

Cytoreductive surgery (CRS) combined with hyperthermic intraperitoneal chemotherapy (HIPEC) is an established treatment for selected peritoneal surface malignancies. However, postoperative hemodynamic fluctuations, fluid shifts, and nephrotoxic chemotherapeutic agents may increase the risk of acute kidney injury (AKI). Early postoperative lactate levels and lactate clearance are markers of tissue perfusion and metabolic recovery, but their prognostic role after HIPEC remains unclear.

To evaluate the association between early postoperative lactate dynamics (0-h and 12-h lactate levels and lactate clearance) and AKI, defined by KDIGO criteria, in patients undergoing HIPEC. Secondary aims were to assess the relationship of lactate dynamics with ICU length of stay and mortality.

This retrospective, single- center cohort included 98 patients who underwent CRS-HIPEC between 2019 and 2024. Demographic, perioperative, and postoperative data were collected. Lactate clearance was calculated from 0-h and 12-h lactate values. AKI was defined according to KDIGO criteria. Statistical comparisons and ROC curve analysis were performed, with p < 0.05 considered significant.

AKI occurred in 32.7% of patients. Intraoperative inotrope use was significantly associated with AKI. Patients with AKI had longer ICU length of stay and higher mortality. The 12-h lactate level was significantly higher in the AKI group and showed limited but significant predictive value for AKI (AUC = 0.623). A threshold above 1.9 mmol/L indicated higher risk. Elevated 12-h lactate and negative lactate clearance were also strong predictors of mortality.

Postoperative 12-h lactate was associated with AKI and strongly predicted mortality, whereas lactate clearance was not predictive of AKI. Elevated postoperative 12-h lactate and negative clearance may serve as simple and early biomarkers for risk stratification following HIPEC.