title: Early hyperlactatemia predicts pancreatic fistula after surgery.
abstract: BACKGROUND
  Postoperative pancreatic fistula (POPF) is a major complication after pancreatic surgery and results from an impaired healing of the pancreatic enteric anastomosis. Whether perioperative hemodynamic fluid management aiming to provide an adequate tissue perfusion could influence the occurrence of POPF is unknown. Serum lactate level is a well-recognized marker of decreased tissue perfusion and is known to be associated with higher morbidity and mortality in various postoperative settings. We aimed to determine in a retrospective high-volume center's cohort whether postoperative hyperlactatemia could predict POPF occurrence.
  
  
  METHODS
  We conducted a retrospective analysis of 96 consecutive patients admitted in the intensive care unit (ICU) after pancreaticoduodenectomy or distal pancreatectomy. Univariate analysis was conducted to compare lactate levels at 6 h between patients evolving with versus without POPF. A logistic regression model was developed and included potential confounding factors.
  
  
  RESULTS
  POPF occurred in 28 patients (29 %). Serum lactate level 6 h after admission was significantly higher in the POPF group (2.8 mmol/L [95 % confidence interval (CI): 2.1-3.5] versus 1.8 mmol/L [95 % CI: 1.8-2.4], p-value = 0.04) whereas it did not differ at ICU admission or at 12 h. Despite similar cumulative fluid balance, fluid intake and vasopressor use, hyperlactatemia > 2.5 mmol/L (Odds ratio (OR): 3.58; 95 % CI: 1.22-10.48; p-value = 0.020) and red blood cells transfusion (OR: 1.24; 95 % CI: 1.03-1.49; p-value = 0.022) were found to be independent predictive factors of POPF occurrence.
  
  
  CONCLUSIONS
  In patients undergoing partial pancreatectomy, hyperlactatemia measured 6 h after ICU admission is a predictive factor for the occurrence of POPF. Inflammatory changes after surgery may account for this observation and should be further evaluated.
authors.affiliation: Department of Critical Care Medicine, Cliniques Universitaires Saint Luc, Université Catholique de Louvain (UCL), Avenue Hippocrate 10, B-1200, Brussels, Belgium. nicolas.deschryver@uclouvain.be.
authors.forename: Nicolas
authors.initials: N
authors.lastname: De Schryver
authors.affiliation: Department of Critical Care Medicine, Cliniques Universitaires Saint Luc, Université Catholique de Louvain (UCL), Avenue Hippocrate 10, B-1200, Brussels, Belgium. xavier.wittebole@uclouvain.be.
authors.forename: Xavier
authors.initials: X
authors.lastname: Wittebole
authors.affiliation: Department of Hepato-biliary Surgery, Cliniques Universitaires Saint Luc, Université Catholique de Louvain (UCL), Avenue Hippocrate 10, B-1200, Brussels, Belgium. catherine.hubert@uclouvain.be.
authors.forename: Catherine
authors.initials: C
authors.lastname: Hubert
authors.affiliation: Department of Hepato-biliary Surgery, Cliniques Universitaires Saint Luc, Université Catholique de Louvain (UCL), Avenue Hippocrate 10, B-1200, Brussels, Belgium. jean-francois.gigot@uclouvain.be.
authors.forename: Jean-François
authors.initials: JF
authors.lastname: Gigot
authors.affiliation: Department of Critical Care Medicine, Cliniques Universitaires Saint Luc, Université Catholique de Louvain (UCL), Avenue Hippocrate 10, B-1200, Brussels, Belgium. pierre-francois.laterre@uclouvain.be.
authors.forename: Pierre-François
authors.initials: PF
authors.lastname: Laterre
authors.affiliation: Department of Critical Care Medicine, Cliniques Universitaires Saint Luc, Université Catholique de Louvain (UCL), Avenue Hippocrate 10, B-1200, Brussels, Belgium. diego.castanares@uclouvain.be.
authors.forename: Diego
authors.initials: D
authors.lastname: Castanares-Zapatero
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D065906:Hyperlactatemia / Q000453:epidemiology*; D007362:Intensive Care Units; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D010180:Pancreatectomy / Q000009:adverse effects* / Q000379:methods; D010185:Pancreatic Fistula / Q000453:epidemiology* / Q000209:etiology; D016577:Pancreaticoduodenectomy / Q000009:adverse effects* / Q000379:methods; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology; D012189:Retrospective Studies; D012307:Risk Factors