Serum arterial lactate concentration predicts mortality and organ dysfunction following liver resection.
BACKGROUND
The aim of this study was to determine if the post-operative serum arterial lactate concentration is associated with mortality, length of hospital stay or complications following hepatic resection.


METHODS
Serum lactate concentration was recorded at the end of liver resection in a consecutive series of 488 patients over a seven-year period. Liver function, coagulation and electrolyte tests were performed post-operatively. Renal dysfunction was defined as a creatinine rise of >1.5x the pre-operative value.


RESULTS
The median lactate was 2.8 mmol/L (0.6 to 16 mmol/L) and was elevated (≥2 mmol/L) in 72% of patients. The lactate concentration was associated with peak post-operative bilirubin, prothrombin time, renal dysfunction, length of hospital stay and 90-day mortality (P < 0.001). The 90-day mortality in patients with a post-operative lactate ≥6 mmol/L was 28% compared to 0.7% in those with lactate ≤2 mmol/L. Pre-operative diabetes, number of segments resected, the surgeon's assessment of liver parenchyma, blood loss and transfusion were independently associated with lactate concentration.


CONCLUSIONS
Initial post-operative lactate concentration is a useful predictor of outcome following hepatic resection. Patients with normal post-operative lactate are unlikely to suffer significant hepatic or renal dysfunction and may not require intensive monitoring or critical care.
Hepatobiliary Surgery, Plymouth Hospitals NHS Trust, Derriford Hospital, Derriford Road, Plymouth, Devon PL6 8DH, UK.|Peninsula College of Medicine and Dentistry, University of Exeter and Plymouth University, Research Way, Plymouth, Devon PL6 8BU, UK.
Matthew G
MG
Wiggans
Department of Anaesthetics, Plymouth Hospitals NHS Trust, Derriford Hospital, Derriford Road, Plymouth, Devon PL6 8DH, UK.
Tim
T
Starkie
Centre for Health Statistics, Tamar Science Park, Davy Road, Plymouth, Devon PL6 8BX, UK.
Golnaz
G
Shahtahmassebi
Department of Anaesthetics, Plymouth Hospitals NHS Trust, Derriford Hospital, Derriford Road, Plymouth, Devon PL6 8DH, UK.
Tom
T
Woolley
Department of Anaesthetics, Plymouth Hospitals NHS Trust, Derriford Hospital, Derriford Road, Plymouth, Devon PL6 8DH, UK.
David
D
Birt
Department of Anaesthetics, Plymouth Hospitals NHS Trust, Derriford Hospital, Derriford Road, Plymouth, Devon PL6 8DH, UK.
Paul
P
Erasmus
Department of Anaesthetics, Plymouth Hospitals NHS Trust, Derriford Hospital, Derriford Road, Plymouth, Devon PL6 8DH, UK.
Ian
I
Anderson
Hepatobiliary Surgery, Plymouth Hospitals NHS Trust, Derriford Hospital, Derriford Road, Plymouth, Devon PL6 8DH, UK.
Matthew J
MJ
Bowles
Hepatobiliary Surgery, Plymouth Hospitals NHS Trust, Derriford Hospital, Derriford Road, Plymouth, Devon PL6 8DH, UK.
Somaiah
S
Aroori
Hepatobiliary Surgery, Plymouth Hospitals NHS Trust, Derriford Hospital, Derriford Road, Plymouth, Devon PL6 8DH, UK.|Peninsula College of Medicine and Dentistry, University of Exeter and Plymouth University, Research Way, Plymouth, Devon PL6 8BU, UK.
David A
DA
Stell