title: Basic arterial blood gas biomarkers as a predictor of mortality in tetralogy of Fallot patients.
abstract: BACKGROUND
  Serum lactate and base deficit have been shown to be a predictor of morbidity and mortality in critically ill patients. Poor preoperative oxygenation appears to be one of the significant factors that affects early mortality in tetralogy of Fallot (TOF). There is little published literature evaluating the utility of serum lactate, base excess (BE), and oxygen partial pressure (PO 2 ) as simple, widely available, prognostic markers in patients undergoing surgical repair of TOF.
  
  
  METHODS
  This prospective, observational study was conducted in 150 TOF patients, undergoing elective intracardiac repair. PO 2 , BE, and lactate levels at three different time intervals were recorded. Arterial blood samples were collected after induction (T1), after cardiopulmonary bypass (T2), and 48 h (T3) after surgery in the Intensive Care Unit (ICU). To observe the changes in PO 2 , BE, and lactate levels over a period of time, repeated measures analysis was performed with Bonferroni method. The receiver operating characteristics (ROC) analysis was used to find area under curve (AUC) and cutoff values of various biomarkers for predicting mortality in ICU.
  
  
  RESULTS
  The patients who could not survive showed significant elevated lactate levels at baseline (T1) and postoperatively (T2) as compared to patients who survived after surgery (P < 0.001). However, in nonsurvivors, the BE value decreased significantly in the postoperative period in comparison to survivors (-2.8 ± 4.27 vs. 5.04 ± 2.06) (P < 0.001). In nonsurvivors, there was a significant fall of PO 2 to a mean value of 59.86 ± 15.09 in ICU (T3), whereas those who survived had a PO 2 of 125.86 ± 95.09 (P < 0.001). The ROC curve analysis showed that lactate levels (T3) have highest mortality predictive value (AUC: 96.9%) as compared to BE (AUC: 94.5%) and PO 2 (AUC: 81.1%).
  
  
  CONCLUSIONS
  Serum lactate and BE may be used as prognostic markers to predict mortality in patients undergoing TOF repair. The routine analysis of these simple, fast, widely available, and cost-effective biomarkers should be encouraged to predict prognosis of TOF patients.
authors.affiliation: Department of Cardiac Anaesthesia, CTC, AIIMS, New Delhi, India.
authors.forename: Vandana
authors.initials: V
authors.lastname: Bhardwaj
authors.affiliation: Department of Cardiac Anaesthesia, CTC, AIIMS, New Delhi, India.
authors.forename: Poonam Malhotra
authors.initials: PM
authors.lastname: Kapoor
authors.affiliation: Department of Cardiac Anaesthesia, CTC, AIIMS, New Delhi, India.
authors.forename: Kalpana
authors.initials: K
authors.lastname: Irpachi
authors.affiliation: Department of Cardiac Anaesthesia, CTC, AIIMS, New Delhi, India.
authors.forename: Suruchi
authors.initials: S
authors.lastname: Ladha
authors.affiliation: Department of CTVS, CTC, AIIMS, New Delhi, India.
authors.forename: Ujjwal Kumar
authors.initials: UK
authors.lastname: Chowdhury
mesh_terms: D000293:Adolescent; D019540:Area Under Curve; D015415:Biomarkers / Q000097:blood; D001784:Blood Gas Analysis / Q000379:methods*; D005260:Female; D006801:Humans; D019344:Lactic Acid / Q000097:blood*; D008297:Male; D010313:Partial Pressure; D011446:Prospective Studies; D013771:Tetralogy of Fallot / Q000401:mortality*
chemical_list: D015415:Biomarkers; D019344:Lactic Acid