title: Use of Postoperative Peak Arterial Lactate Level to Predict Outcome After Cardiac Surgery.
abstract: OBJECTIVE
  In the present study, the authors investigated the predictive value of postoperative peak arterial lactate levels for early and late mortality after cardiac surgery.
  
  
  METHODS
  Retrospective analysis of prospectively collected data.
  
  
  METHODS
  Single-center study in an academic hospital.
  
  
  METHODS
  Adult patients who underwent cardiac surgery between 2004 and 2014 (n = 16,376).
  
  
  METHODS
  Different cardiac surgical procedures.
  
  
  RESULTS
  Patients were classified according to the peak arterial lactate level (PALL) within 3 days postoperatively. Logistic regression analysis and Cox regression analysis were performed to identify postoperative peak arterial lactate level as a predictor for early and late mortality respectively. In 8460 patients (51.7%), lactate was not measured postoperatively because these patients were managed according to the fast-track protocol. These patients constituted group 1 in our population but were excluded from the regression analysis. The remaining patients (n = 7,916; 48.3%) were divided according to the postoperative peak arterial lactate level (PALL): PALL<5 mmol/L (group 2), PALL 5 to 10 mmol/L (group 3), and PALL of>10 mmol/L (group 4). Early mortality was 3.7%, 20.4%, and 62.9% in groups 2, 3, and 4 respectively (p<0.0001). This mortality rate was significantly higher than that of group 1 (1.6%); p<0.0001. Multivariate regression analyses revealed postoperative peak arterial lactate as a significant predictor of 30-day mortality (odds ratio = 1.44 [1.39-1.48], p<0.001) as well as for late mortality (hazard ratio = 1.05 [1.01-1.10], p<0.025).
  
  
  CONCLUSIONS
  Postoperative peak arterial lactate level in patients undergoing cardiac surgery is an independent predictor for both early and late mortality.
authors.affiliation: Department of Anaesthesiology, Catharina Hospital, Eindhoven, The Netherlands; Intensive Care Unit, Catharina Hospital, Eindhoven, The Netherlands.
authors.forename: Marco C
authors.initials: MC
authors.lastname: Haanschoten
authors.affiliation: Intensive Care Unit, Catharina Hospital, Eindhoven, The Netherlands.
authors.forename: Herman G
authors.initials: HG
authors.lastname: Kreeftenberg
authors.affiliation: Department of Anaesthesiology, Catharina Hospital, Eindhoven, The Netherlands; Intensive Care Unit, Catharina Hospital, Eindhoven, The Netherlands.
authors.forename: R
authors.initials: R
authors.lastname: Arthur Bouwman
authors.affiliation: Department of Cardiothoracic Surgery, Catharina Hospital, Eindhoven, The Netherlands.
authors.forename: Albert H M
authors.initials: AH
authors.lastname: van Straten
authors.affiliation: Department of Anaesthesiology, Maastricht University Hospital, Maastricht, The Netherlands.
authors.forename: Wolfgang F
authors.initials: WF
authors.lastname: Buhre
authors.affiliation: Department of Cardiothoracic Surgery, Catharina Hospital, Eindhoven, The Netherlands. Electronic address: mohammed.soliman@catharinaziekenhuis.nl.
authors.forename: Mohamed A
authors.initials: MA
authors.lastname: Soliman Hamad
mesh_terms: D000368:Aged; D015415:Biomarkers / Q000097:blood; D006348:Cardiac Surgical Procedures / Q000009:adverse effects* / Q000401:mortality; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D065906:Hyperlactatemia / Q000209:etiology / Q000401:mortality; D053208:Kaplan-Meier Estimate; D019344:Lactic Acid / Q000097:blood*; D008297:Male; D008875:Middle Aged; D009426:Netherlands / Q000453:epidemiology; D011184:Postoperative Period; D011237:Predictive Value of Tests; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors
chemical_list: D015415:Biomarkers; D019344:Lactic Acid
keywords: cardiac surgery, hyperlactatemia, mortality; outcomes; survival analysis