Hyperlactatemia and worse outcomes in patients undergoing cardiac surgery: a retrospective cohort study
Palavras-chave:
Perioperative procedures, Hyperlactatemia, Hospital mortality, Critical care outcomesResumo
Objective: Identify the factors, complications, and outcomes associated with hyperlactatemia in patients undergoing cardiac surgery. Methods: A retrospective cohort study including patients with hyperlactatemia admitted to the surgical intensive care unit (SICU) immediately after cardiac surgery. Patients were divided into 2 groups based on baseline lactate levels: hyperlactatemia group (HL, lactate levels ≥ 3 mmol/L) and normal lactate group (NL, lactate levels < 3 mmol/L). Results: Of 1304 patients, 589 (45.2%) had hyperlactatemia in the postoperative period of cardiac surgery. The LH group when compared to the NL group, respectively, presented a higher mean value for the EuroSCORE (3.5 ± 2.4 vs 3.2 ± 2.3, p = 0.018), higher mortality rates (13.6% vs 3.9%, p <0.001), acute kidney injury (52.6% vs. 36.8%; p <0.001), longer ICU stay (4 days [3 - 6]) vs. 5 days [3 - 7]; p <0.001), required mechanical ventilation for longer in the first 24 hours (9.4% vs. 18.1%; p <0.001) and 48 hours (7.7% vs. 15.1%; p <0.001 ) after admission to the ICU and had higher rates of use of IABP (8.1% vs. 5.5%; p = 0.034). The survival curves show that the overall survival was better in the patients in the NL group. Conclusions: In the postoperative period of cardiac surgery, the prevalence of hyperlactatemia was 45.2% with worse outcomes for this group. Patients in the HL group had higher mortality, higher frequency of mechanical ventilation in the first 24 and 48 hours, higher incidence of acute kidney injury, more need for the use of IABP, and longer length of stay SICU.
Referências
Garcia-Camacho C. Continuous ultrafiltration during extracorporeal circulation and its effect on lactatemia: a randomized controlled trial. PLOS ONE. 2020;15(11). https://doi.org/10.1371/journal.pone.0242411
Minton J, Sidebotham DA. Hyperlactatemia and Cardiac Surgery. J Extra Corpor Technol [Internet]. 2017[cited 2021 Apr 01];49(1):7-15. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5347225/
Couto-Mallón D, González-Vílchez F, Almenar-Bonet L, et al. Prognostic value of serum lactate levels in patients undergoing urgent heart transplant: a subanalysis of the ASIS-TC Spanish Multicenter Study. Rev Esp Cardiol (Engl Ed). 2019;72(3):208-14. https://doi.org/10.1016/j.rec.2018.02.021
Yang HH, Chang JC, Jhan JY. Prognostic value of peak lactate during cardiopulmonary bypass in adult cardiac surgeries: a retrospective cohort study. Tzu Chi Med J. 2020;32(4):386-91. https://doi.org/10.4103/tcmj.tcmj_215_19
Kędziora A, Wierzbicki K, Piątek J. Postoperative hyperlactatemia and serum lactate level trends among heart transplant recipients. PeerJ. 2020;8:e8334. https://doi.org/10.7717/peerj.8334
Piot J, Hébrard A, Durand M, Payen JF, Albaladejo P. An elevated respiratory quotient predicts complications after cardiac surgery under extracorporeal circulation: an observational pilot study. J Clin Monit Comput. 2019;33(1):145-53. https://doi.org/10.1007/s10877-018-0137-0
Draben L. Hyperlactatemia and Patient Outcomes After Pediatric Cardiac Surgery. Crit Care Nurse. 2018;38(5):e1-e6. https://doi.org/10.4037/ccn2018910
Şahutoğlu C, Yaşar A, Kocabaş S, Aşkar FZ, Ayık MF, Atay Y. Correlation between serum lactate levels and outcome in pediatric patients undergoing congenital heart surgery. Turk Gogus Kalp Damar Cerrahisi Derg. 2018;26(3):375-85. https://doi.org/10.5606/tgkdc.dergisi.2018.15791
Group KDIGO KBPW. KDIGO 2021 Clinical Practice Guideline for the Management of Blood Pressure in Chronic Kidney Disease. Kidney Int. 03 2021;99(3S):S1-S87. https://doi.org/10.1016/j.kint.2020.11.003
Hoshino Y, Kinoshita O, Ono M. The Incidence, Risk Factors, and Outcomes of Hyperlactatemia after Heart Transplantation. Int Heart J. Jan 2018;59(1):81-6. https://doi.org/10.1536/ihj.17-146
Ferreruela M, Raurich JM, Ayestarán I, Llompart-Pou JA. Hyperlactatemia in ICU patients: incidence, causes and associated mortality. J Crit Care. 12 2017;42:200-205. https://doi.org/10.1016/j.jcrc.2017.07.039
Boldt J, Piper S, Murray P, Lehmann A. Case 2-1999. Severe lactic acidosis after cardiac surgery: sign of perfusion deficits? J Cardiothorac Vasc Anesth. Apr 1999;13(2):220-4. https://doi.org/10.1016/s1053-0770(99)90093-9
Totaro RJ, Raper RF. Epinephrine-induced lactic acidosis following cardiopulmonary bypass. Crit Care Med. 1997;25(10):1693-9. https://doi.org/10.1097/00003246-199710000-00019
Lenkin PI, Smetkin AA, Hussain A, et al. Continuous monitoring of lactate using intravascular microdialysis in high-risk cardiac surgery: a prospective observational study. J Cardiothorac Vasc Anesth. 2017;31(1):37-44. https://doi.org/10.1053/j.jvca.2016.04.013
Zante B, Reichenspurner H, Kubik M, Kluge S, Schefold JC, Pfortmueller CA. Base excess is superior to lactate-levels in prediction of ICU mortality after cardiac surgery. PLoS One. 2018;13(10):e0205309. https://doi.org/10.1371/journal.pone.0205309
Matteucci M, Ferrarese S, Cantore C. Hyperlactatemia during cardiopulmonary bypass: risk factors and impact on surgical results with a focus on the long-term outcome. Perfusion. 2020;35(8):756-62. https://doi.org/10.1177/0267659120907440
Mak NT, Iqbal S, de Varennes B, Khwaja K. Outcomes of post-cardiac surgery patients with persistent hyperlactatemia in the intensive care unit: a matched cohort study. J Cardiothorac Surg. 2016;11:33. https://doi.org/10.1186/s13019-016-0411-5
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