title: Postoperative arterial blood lactate level as a mortality marker in patients with colorectal perforation.
abstract: OBJECTIVE
  This study aims to assess the clinical relevance of postoperative arterial blood lactate (LAC) level as a prognostic factor in patients with colorectal perforation.
  
  
  METHODS
  Forty-two patients (22 males, 20 females; mean age, 70.8 years) underwent emergency surgery for colorectal perforation. The patients were divided into mortality and survivor groups. As a prognostic scoring system, Acute Physiological and Chronic Health Evaluation II (APACHE-II), Sequential Organ Failure Assessment (SOFA), and Systemic Inflammatory Response Syndrome criteria were calculated. These scores, postoperative LAC level, and other data, including site and etiology of perforation, elapsed time from onset to surgery (eTIME), preoperative white blood cell (WBC) and platelet counts, preoperative C-reactive protein (CRP), and preoperative arterial blood base excess were assessed between the groups.
  
  
  RESULTS
  The total mortality rate was 33.3 %. On univariate analysis, the APACHE-II and SOFA scores were significantly higher, and eTIME was significantly longer in the mortality group than in the survivor group. The postoperative LAC level was significantly higher in the mortality group (43.1 ± 14.1 mg/dl) than in the survivor group (23.8 ± 12.7 mg/dl; p < 0.001), and the preoperative WBC was significantly lower in the mortality group than in the survivor group. Multivariate logistic regression analysis using the mortality risk factors determined by univariate analysis (eTIME, APACHE-II score, SOFA score, preoperative WBC count, and postoperative LAC) demonstrated that postoperative LAC level was an independent risk factor for mortality.
  
  
  CONCLUSIONS
  High postoperative LAC level was a useful factor for predicting high mortality rate in patients with colorectal perforation.
authors.affiliation: Department of Surgery, Ibaraki Medical Center, Tokyo Medical University, 3-20-1, Chuo Ami-Machi, Inasiki-Gun, Ibaraki, 300-0395, Japan, shima-j@tokyo-med.ac.jp.
authors.forename: Jiro
authors.initials: J
authors.lastname: Shimazaki
authors.forename: Gyo
authors.initials: G
authors.lastname: Motohashi
authors.forename: Kiyotaka
authors.initials: K
authors.lastname: Nishida
authors.forename: Hideyuki
authors.initials: H
authors.lastname: Ubukata
authors.forename: Takafumi
authors.initials: T
authors.lastname: Tabuchi
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001158:Arteries / Q000378:metabolism*; D015415:Biomarkers / Q000097:blood; D005260:Female; D006801:Humans; D007416:Intestinal Perforation / Q000097:blood* / Q000401:mortality*; D007773:Lactates / Q000097:blood*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011184:Postoperative Period; D011300:Preoperative Care; D012044:Regression Analysis; D012307:Risk Factors
chemical_list: D015415:Biomarkers; D007773:Lactates