title: Arterial Lactate Concentration at the End of an Elective Hepatectomy Is an Early Predictor of the Postoperative Course and a Potential Surrogate of Intraoperative Events.
abstract: OBJECTIVE
  To test the prognostic impact of arterial lactate concentration at the end-of-surgery (LCT-EOS) on postoperative outcome after elective liver-resections and to identify the predictors of an increase in LCT-EOS.
  
  
  BACKGROUND
  A recent systematic-review of risk-prediction-models for liver resections has evidenced their poor accuracy and a deficit in the evaluation of intraoperative events. LCT-EOS is a marker of impaired tissue oxygenation.
  
  
  METHODS
  This prospectively-designed study was based on a training-cohort of 519 patients and a validation-cohort of 466 patients. For each of the endpoints (high comprehensive complication index (CCI) scores, 90-day-mortality and severe-morbidity), prognostic-models were built by logistic-regression using the training-cohort. These models were thereafter tested in the validation-cohort and their performance (discrimination, accuracy, calibration) assessed. Independent predictors of LCT-EOS were also identified.
  
  
  RESULTS
  In the training-cohort, LCT-EOS cutoff best discriminating high-CCI, 90-day-mortality and severe-morbidity were 3, 3 and 2.8 mmol/L (and the corresponding AUROC 0.86, 0.87 and 0.76). LCT-EOS was an independent predictor of endpoints and adding LCT-EOS to the other predictors increased by 16.4%, 34.5% and 17.7% the accuracy of the models for high-CCI, 90-day-mortality and severe-morbidity, respectively. The models had high calibration and accuracy. Diabetes, repeat-hepatectomy, major-hepatectomy, synchronous-major-procedure, inflow-occlusion and blood-transfusion were independent predictors of LCT-EOS >3 mmol/L.
  
  
  CONCLUSIONS
  LCT-EOS >3 mmol/L is an early predictor of postoperative-outcome and should be used as a tool to determine patients requiring critical-care and as an endpoint in studies measuring the impact of perioperative interventions.
authors.affiliation: *AP-HP Hôpital Paul-Brousse, Centre Hépato-Biliaire, Villejuif, France †CHRU de Lille, Hôpital Huriez, Service de Chirurgie Digestive et Transplantation, Lille, France ‡CHU d'Amiens Picardie, Hôpital Sud Amiens, Service de Chirurgie Digestive, Amiens, France §AP-HP Hôpital Paul-Brousse, Service d'Anesthésie-Réanimation, Villejuif, France ¶CHRU de Lille, Hôpital Huriez, Département d'Anesthésie-Réanimation, Lille, France ||AP-HP Hôpital Beaujon, Service d'Anesthésie-Réanimation, Paris, France **AP-HP Hôpital Beaujon, Service de Chirurgie Hépato-Biliaire et Transplantation, Clichy, Université Paris Diderot, Sorbonne Paris Cité, Paris, France.
authors.forename: Eric
authors.initials: E
authors.lastname: Vibert
authors.forename: Emmanuel
authors.initials: E
authors.lastname: Boleslawski
authors.forename: Cyril
authors.initials: C
authors.lastname: Cosse
authors.forename: Rene
authors.initials: R
authors.lastname: Adam
authors.forename: Denis
authors.initials: D
authors.lastname: Castaing
authors.forename: Daniel
authors.initials: D
authors.lastname: Cherqui
authors.forename: Salima
authors.initials: S
authors.lastname: Naili
authors.forename: Jean-Marc
authors.initials: JM
authors.lastname: Régimbeau
authors.forename: Antonio Sa
authors.initials: AS
authors.lastname: Cunha
authors.forename: Stephanie
authors.initials: S
authors.lastname: Truant
authors.forename: Maher
authors.initials: M
authors.lastname: Fleyfel
authors.forename: François-René
authors.initials: FR
authors.lastname: Pruvot
authors.forename: Catherine
authors.initials: C
authors.lastname: Paugam-Burtz
authors.forename: Olivier
authors.initials: O
authors.lastname: Farges
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D042241:Early Diagnosis; D017558:Elective Surgical Procedures; D005260:Female; D005602:France / Q000453:epidemiology; D006498:Hepatectomy / Q000379:methods*; D006801:Humans; D015994:Incidence; D007431:Intraoperative Complications / Q000097:blood / Q000175:diagnosis* / Q000453:epidemiology; D019344:Lactic Acid / Q000097:blood*; D008297:Male; D008875:Middle Aged; D011184:Postoperative Period; D011379:Prognosis; D011446:Prospective Studies; D018570:Risk Assessment / Q000379:methods*; D012307:Risk Factors; D015996:Survival Rate / Q000639:trends; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D019344:Lactic Acid