title: Lactate, endothelin, and central venous oxygen saturation as predictors of mortality in patients with Tetralogy of Fallot.
abstract: BACKGROUND
  Lactate and central venous oxygen saturation (ScVO2) are well known biomarkers for adequacy of tissue oxygenation. Endothelin, an inflammatory marker has been associated with patient's nutritional status and degree of cyanosis. The aim of this study was to explore the hypothesis that lactate, ScVO2 and endothelin before induction may be predictive of mortality in pediatric cardiac surgery.
  
  
  METHODS
  We conducted a prospective observational study of 150 pediatric (6 months to 12 years) patients who were posted for intracardiac repair for Tetralogy of Fallot and measured lactate, ScVO2 and endothelin before induction (T1), 20 minutes after protamine administration (T2) and 24 hours after admission to ICU (T3).
  
  
  RESULTS
  Preinduction lactate and endothelin levels were found to predict mortality in patients of Tetralogy of Fallot with an odds ratio of 6.020 (95% CI 2.111-17.168) and 1.292(95% CI 1.091-1.531) respectively. In the ROC curve analysis for lactate at T1, the AUC was 0.713 (95% CI 0.526-0.899 P = 0.019). At the cutoff value of 1.750 mmol/lt, the sensitivity and specificity for the prediction of mortality was 63.6% and 65.5%, respectively. For endothelin at T1, the AUC was 0.699 (95% CI 0.516-0.883, P = 0.028) and the cutoff value was ≤2.50 (sensitivity, 63.6%; specificity, 58.3 %). ScVO2 (odds ratio 0.85) at all three time intervals, suggested that improving ScVO2 can lead to 15% reduction in mortality.
  
  
  CONCLUSIONS
  Lactate, ScVO2 and endothelin all showed association with mortality with lactate having the maximum prediction. Lactate was found to be an independent, reliable and cost-effective measure of prediction of mortality in patients with Tetralogy of Fallot.
authors.affiliation: Department of Cardiac Anaesthesia, Cardio Thoracic Centre, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India.
authors.forename: Poonam Malhotra
authors.initials: PM
authors.lastname: Kapoor
authors.forename: Ira
authors.initials: I
authors.lastname: Dhawan
authors.forename: Pawan
authors.initials: P
authors.lastname: Jain
authors.forename: Ujjwal
authors.initials: U
authors.lastname: Chowdhury
mesh_terms: D019540:Area Under Curve; D015415:Biomarkers; D006348:Cardiac Surgical Procedures / Q000401:mortality*; D002648:Child; D002675:Child, Preschool; D016232:Endothelins / Q000097:blood*; D005260:Female; D006801:Humans; D007223:Infant; D019344:Lactic Acid / Q000097:blood*; D008297:Male; D010100:Oxygen / Q000097:blood*; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012372:ROC Curve; D013771:Tetralogy of Fallot / Q000401:mortality* / Q000601:surgery*; D013832:Thiamine Deficiency / Q000150:complications; D016896:Treatment Outcome
chemical_list: D015415:Biomarkers; D016232:Endothelins; D019344:Lactic Acid; D010100:Oxygen