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Published on: May 28, 2019
Serum lactates correlate with mortality after operations for complex congenital heart disease
I M Cheifetz1, F H Kern, S R Schulman
1Department of Pediatrics, Duke Children's Hospital, Duke University Medical Center, Durham, North Carolina 27710, USA. cheif002@mc.duke.edu
Insights
Serum lactate levels can predict mortality in infants after heart surgery. Higher lactate levels post-cardiopulmonary bypass indicate increased risk in children with congenital heart disease.
Area of Science:
- Pediatric Cardiology
- Critical Care Medicine
- Biomarkers in Medicine
Background:
- Complex congenital heart disease necessitates cardiopulmonary bypass in infants.
- Assessing post-operative outcomes in this vulnerable population is crucial.
- Predictive markers for mortality are needed for early intervention.
Purpose of the Study:
- To investigate serum lactate levels as a predictor of mortality.
- To evaluate lactate levels in infants undergoing cardiopulmonary bypass for congenital heart disease.
Main Methods:
- Analysis of initial, maximum, and 4-6 hour post-operative lactate levels.
- Study included 48 infants (<1 year) undergoing cardiopulmonary bypass.
- Comparison of lactate levels between survivors and non-survivors.
Main Results:
- Significantly higher lactate levels (initial, max, 4-6h) in non-survivors compared to survivors.
- Specific lactate thresholds (initial <7, max <9, 4-6h <4 mmol/L) were associated with survival.
- Lactate levels demonstrated a clear correlation with mortality risk.
Conclusions:
- Serum lactate levels show potential as a predictive biomarker for mortality in infants post-cardiopulmonary bypass.
- Elevated lactate post-complex congenital heart surgery warrants close monitoring for potential mortality.
- Lactate monitoring can aid in risk stratification and clinical decision-making.
Background:
The objective of this study was to determine whether serum lactate levels predict mortality in children less than 1 year of age who have undergone cardiopulmonary bypass and operations for complex congenital heart disease.
Methods:
The initial lactate, maximum lactate, and lactate levels at 4 to 6 hours after operation were analyzed for each of 48 children less than 12 months of age who underwent cardiopulmonary bypass.
Results:
Data were analyzed for the 6 patients who died and the 42 patients who survived. For the patients who died, the initial postoperative serum lactate, maximum lactate, and 4- to 6-hour lactate levels were significantly higher than those in the patients who survived. All patients with an initial lactate less than 7 mmol/L, a maximum lactate less than 9 mmol/L, or a 4- to 6-hour lactate level less than 4 mmol/L survived to hospital discharge.
Conclusions:
Serum lactate levels may be a useful predictor of mortality in children less than 1 year of age who have undergone cardiopulmonary bypass. An elevation in serum lactate level after a complex operation for congenital heart disease should be taken as a serious indicator of potential mortality.
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