Intraoperative serum lactate levels as a prognostic predictor of outcome for emergency abdominal surgery: a retrospective study
Abstract Background The relationship between intraoperative lactate levels and prognosis after emergency gastrointestinal surgery remains unclear. The purpose of this study was to investigate the prognostic value of intraoperative lactate levels for predicting in-hospital mortality, and to examine i...
| Main Authors: | , , , , , |
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| Format: | Article |
| Language: | English |
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BMC
2023-06-01
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| Series: | BMC Surgery |
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| Online Access: | https://doi.org/10.1186/s12893-023-02075-7 |
| _version_ | 1797801643453972480 |
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| author | Shinji Sugita Masashi Ishikawa Takahiro Sakuma Masumi Iizuka Sayako Hanai Atsuhiro Sakamoto |
| author_facet | Shinji Sugita Masashi Ishikawa Takahiro Sakuma Masumi Iizuka Sayako Hanai Atsuhiro Sakamoto |
| author_sort | Shinji Sugita |
| collection | DOAJ |
| description | Abstract Background The relationship between intraoperative lactate levels and prognosis after emergency gastrointestinal surgery remains unclear. The purpose of this study was to investigate the prognostic value of intraoperative lactate levels for predicting in-hospital mortality, and to examine intraoperative hemodynamic managements. Methods We conducted a retrospective observational study of emergency GI surgeries performed at our institution between 2011 and 2020. The study group comprised patients admitted to intensive care units postoperatively, and whose intraoperative and postoperative lactate levels were available. Intraoperative peak lactate levels (intra-LACs) were selected for analysis, and in-hospital mortality was set as the primary outcome. The prognostic value of intra-LAC was assessed using logistic regression and receiver operating characteristic (ROC) curve analysis. Results Of the 551 patients included in the study, 120 died postoperatively. Intra-LAC in the group who survived and the group that died was 1.80 [interquartile range [IQR], 1.19–3.01] mmol/L and 4.22 [IQR, 2.15–7.13] mmol/L (P < 0.001), respectively. Patients who died had larger volumes of red blood cell (RBC) transfusions and fluid administration, and were administered higher doses of vasoactive drugs. Logistic regression analysis showed that intra-LAC was an independent predictor of postoperative mortality (odds ratio [OR] 1.210, 95% CI 1.070 –1.360, P = 0.002). The volume of RBCs, fluids transfused, and the amount of vasoactive agents administered were not independent predictors. The area under the curve (AUC) of the ROC curve for intra-LAC for in-hospital mortality was 0.762 (95% confidence interval [CI], 0.711–0.812), with a cutoff value of 3.68 mmol/L by Youden index. Conclusions Intraoperative lactate levels, but not hemodynamic management, were independently associated with increased in-hospital mortality after emergency GI surgery. |
| first_indexed | 2024-03-13T04:53:35Z |
| format | Article |
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| institution | Directory Open Access Journal |
| issn | 1471-2482 |
| language | English |
| last_indexed | 2024-03-13T04:53:35Z |
| publishDate | 2023-06-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Surgery |
| spelling | doaj.art-7815aada99cb43c895e7c47654e0222a2023-06-18T11:05:07ZengBMCBMC Surgery1471-24822023-06-012311910.1186/s12893-023-02075-7Intraoperative serum lactate levels as a prognostic predictor of outcome for emergency abdominal surgery: a retrospective studyShinji Sugita0Masashi Ishikawa1Takahiro Sakuma2Masumi Iizuka3Sayako Hanai4Atsuhiro Sakamoto5Department of Anesthesiology and Pain Medicine, Graduate School of Medicine, Nippon Medical SchoolDepartment of Anesthesiology and Pain Medicine, Graduate School of Medicine, Nippon Medical SchoolDepartment of Anesthesiology and Pain Medicine, Graduate School of Medicine, Nippon Medical SchoolDepartment of Anesthesiology and Pain Medicine, Graduate School of Medicine, Nippon Medical SchoolDepartment of Anesthesiology and Pain Medicine, Graduate School of Medicine, Nippon Medical SchoolDepartment of Anesthesiology and Pain Medicine, Graduate School of Medicine, Nippon Medical SchoolAbstract Background The relationship between intraoperative lactate levels and prognosis after emergency gastrointestinal surgery remains unclear. The purpose of this study was to investigate the prognostic value of intraoperative lactate levels for predicting in-hospital mortality, and to examine intraoperative hemodynamic managements. Methods We conducted a retrospective observational study of emergency GI surgeries performed at our institution between 2011 and 2020. The study group comprised patients admitted to intensive care units postoperatively, and whose intraoperative and postoperative lactate levels were available. Intraoperative peak lactate levels (intra-LACs) were selected for analysis, and in-hospital mortality was set as the primary outcome. The prognostic value of intra-LAC was assessed using logistic regression and receiver operating characteristic (ROC) curve analysis. Results Of the 551 patients included in the study, 120 died postoperatively. Intra-LAC in the group who survived and the group that died was 1.80 [interquartile range [IQR], 1.19–3.01] mmol/L and 4.22 [IQR, 2.15–7.13] mmol/L (P < 0.001), respectively. Patients who died had larger volumes of red blood cell (RBC) transfusions and fluid administration, and were administered higher doses of vasoactive drugs. Logistic regression analysis showed that intra-LAC was an independent predictor of postoperative mortality (odds ratio [OR] 1.210, 95% CI 1.070 –1.360, P = 0.002). The volume of RBCs, fluids transfused, and the amount of vasoactive agents administered were not independent predictors. The area under the curve (AUC) of the ROC curve for intra-LAC for in-hospital mortality was 0.762 (95% confidence interval [CI], 0.711–0.812), with a cutoff value of 3.68 mmol/L by Youden index. Conclusions Intraoperative lactate levels, but not hemodynamic management, were independently associated with increased in-hospital mortality after emergency GI surgery.https://doi.org/10.1186/s12893-023-02075-7HyperlactatemiaRetrospective studyPrognosisEmergency gastrointestinal surgery |
| spellingShingle | Shinji Sugita Masashi Ishikawa Takahiro Sakuma Masumi Iizuka Sayako Hanai Atsuhiro Sakamoto Intraoperative serum lactate levels as a prognostic predictor of outcome for emergency abdominal surgery: a retrospective study BMC Surgery Hyperlactatemia Retrospective study Prognosis Emergency gastrointestinal surgery |
| title | Intraoperative serum lactate levels as a prognostic predictor of outcome for emergency abdominal surgery: a retrospective study |
| title_full | Intraoperative serum lactate levels as a prognostic predictor of outcome for emergency abdominal surgery: a retrospective study |
| title_fullStr | Intraoperative serum lactate levels as a prognostic predictor of outcome for emergency abdominal surgery: a retrospective study |
| title_full_unstemmed | Intraoperative serum lactate levels as a prognostic predictor of outcome for emergency abdominal surgery: a retrospective study |
| title_short | Intraoperative serum lactate levels as a prognostic predictor of outcome for emergency abdominal surgery: a retrospective study |
| title_sort | intraoperative serum lactate levels as a prognostic predictor of outcome for emergency abdominal surgery a retrospective study |
| topic | Hyperlactatemia Retrospective study Prognosis Emergency gastrointestinal surgery |
| url | https://doi.org/10.1186/s12893-023-02075-7 |
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