title: Serum lactate level has prognostic significance after pediatric cardiac surgery.
abstract: OBJECTIVE
  The determination of postoperative course after cardiac surgery has always been a challenging issue. It is more sophisticated in the pediatric age group. The aim of this investigation was to identify whether increased concentrations of lactate in arterial blood has a predictive value for postoperative morbidity and mortality after heart surgery.
  
  
  METHODS
  From May 2002 to June 2003, 60 infants operated on at the authors' institution were included in this prospective study. The patients were divided into 2 groups according to their respective postoperative serum lactate values. After the stabilization period in the intensive care unit (first 3 hours postoperatively), samples for serum lactate were obtained from arterial blood at 3 (t1), 6 (t2), and 12 hours (t3) postoperatively. The patients were subdivided into 2 groups according to their respective mean serum lactate values. A value of 4.8 mmol/L (3 times the normal upper limit) was chosen as a threshold for serum lactate. The patients with a mean value of greater than 4.8 mmol/L (group 1) were compared with the remaining group of patients (group 2). The relationship between serum mean lactate level and intraoperative and postoperative clinical variables was evaluated.
  
  
  RESULTS
  Among the patients in this study, 26 (43.3%) had a serum mean lactate level more than 4.8 mmol/L and 34 (56.7%) had a level of 4.8 mmol/L or less. Age, aortic cross-clamping time, cardiopulmonary bypass time, and the lowest hematocrit during cardiopulmonary bypass were significant variables that influenced the postoperative serum mean lactate level. Six patients died in the postoperative period and 54 infants survived. The hospital mortality was significantly higher in group 1 than in group 2 (19.0% v 2.9%; p = 0.037, kappa = 0.179). Multivariate analysis revealed that serum mean lactate level correlated significantly with inotrope score, intubation time, and intensive care unit stay.
  
  
  CONCLUSIONS
  Blood lactate concentration of 4.8 mmol/L or higher during the early postoperative hours identifies a group of patients with increased risk of postoperative morbidity and mortality.
authors.affiliation: Department of Cardiovascular Surgery, Istanbul University, Istanbul, Turkey.
authors.forename: Murat
authors.initials: M
authors.lastname: Basaran
authors.forename: Kenan
authors.initials: K
authors.lastname: Sever
authors.forename: Eylul
authors.initials: E
authors.lastname: Kafali
authors.forename: Murat
authors.initials: M
authors.lastname: Ugurlucan
authors.forename: Omer Ali
authors.initials: OA
authors.lastname: Sayin
authors.forename: Turkan
authors.initials: T
authors.lastname: Tansel
authors.forename: Ufuk
authors.initials: U
authors.lastname: Alpagut
authors.forename: Enver
authors.initials: E
authors.lastname: Dayioglu
authors.forename: Ertan
authors.initials: E
authors.lastname: Onursal
mesh_terms: D006348:Cardiac Surgical Procedures / Q000401:mortality*; D002675:Child, Preschool; D006801:Humans; D019344:Lactic Acid / Q000097:blood*; D015999:Multivariate Analysis; D011184:Postoperative Period; D011379:Prognosis; D012044:Regression Analysis
chemical_list: D019344:Lactic Acid