title: Changes of lactate levels during cardiopulmonary bypass in patients undergoing cardiac transplantation: possible early marker of morbidity and mortality.
abstract: OBJECTIVE
  High levels of lactate are associated with tissue hypoperfusion during cardiac surgery resulting in postoperative morbidity and mortality among patients undergoing cardiopulmonary bypass (CBP). Our goal was to evaluate the change in lactate levels during CBP for their possible predictive value for complications after heart transplant surgery.
  
  
  METHODS
  From January to December 2010 we studied lactate levels in 16 heart transplant patients. Arterial blood samples were collected before, during, and after cardiopulmonary bypass on admission to the intensive care unit (ICU). Lactate levels were measured using the cobas B221 (Roche Diagnostic). The neurological, lung, and kidney complications were associated with mortality within 30 days.
  
  
  RESULTS
  One patient displayed lactate levels > 2 mmol/L before bypass while 4 (25%) showed levels > 4 mmol/L during CPB. Lactate values higher than or equal to 4 mmol/L on ICU admission occurred in nine patients (56%). Postoperative mortality was higher among the group with levels above below 4 mmol/L on ICU admission (18.7% vs 6.2%). Neurological complications were observed in 22% of patients with elevated levels as opposed to none of the patients with levels below 4 mmol/L. Pulmonary complications were noted in 22% of patients with high lactate values versus 0% among the other group.
  
  
  CONCLUSIONS
  Hyperlactemia above certain levels occurring during CPB serve as a biomarker to identify early postoperative morbidity and mortality.
authors.affiliation: Department of Clinical Laboratory Sciences, Virgen del Rocio Hospital, Seville, Spain. janoval@telefonica.net
authors.forename: J A
authors.initials: JA
authors.lastname: Noval-Padillo
authors.forename: C
authors.initials: C
authors.lastname: Serra-Gomez
authors.forename: L
authors.initials: L
authors.lastname: Gomez-Sosa
authors.forename: R
authors.initials: R
authors.lastname: Hinojosa-Perez
authors.forename: M J
authors.initials: MJ
authors.lastname: Huici-Moreno
authors.forename: A
authors.initials: A
authors.lastname: Adsuar
authors.forename: A
authors.initials: A
authors.lastname: Herruzo-Avilés
authors.forename: J L
authors.initials: JL
authors.lastname: Lopez-Romero
authors.forename: A
authors.initials: A
authors.lastname: León-Justel
authors.forename: J M
authors.initials: JM
authors.lastname: Guerrero-Montavez
mesh_terms: D015415:Biomarkers / Q000097:blood; D002315:Cardiopulmonary Bypass / Q000009:adverse effects* / Q000401:mortality; D016027:Heart Transplantation / Q000009:adverse effects* / Q000401:mortality; D017052:Hospital Mortality; D006801:Humans; D019344:Lactic Acid / Q000097:blood*; D011183:Postoperative Complications / Q000097:blood* / Q000209:etiology / Q000401:mortality; D011237:Predictive Value of Tests; D013030:Spain; D013997:Time Factors; D016896:Treatment Outcome; D015854:Up-Regulation
chemical_list: D015415:Biomarkers; D019344:Lactic Acid