Early dynamic behavior of lactate in predicting continuous renal replacement therapy after surgery for acute type A aortic dissection
BackgroundIt has been well known that hyperlactatemia is an independent risk factor for postoperative mortality in patients who received acute type A aortic dissection (ATAAD) surgery. Some patients may require the assistance of continuous renal replacement therapy (CRRT) for acute postoperative ren...
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| Format: | Article |
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Frontiers Media S.A.
2022-07-01
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| Series: | Frontiers in Cardiovascular Medicine |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fcvm.2022.948672/full |
| _version_ | 1818013258111516672 |
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| author | Zhigang Wang Jingfang Xu Yubei Kang Ling Liu Lifang Zhang Dongjin Wang |
| author_facet | Zhigang Wang Jingfang Xu Yubei Kang Ling Liu Lifang Zhang Dongjin Wang |
| author_sort | Zhigang Wang |
| collection | DOAJ |
| description | BackgroundIt has been well known that hyperlactatemia is an independent risk factor for postoperative mortality in patients who received acute type A aortic dissection (ATAAD) surgery. Some patients may require the assistance of continuous renal replacement therapy (CRRT) for acute postoperative renal deficiency and often associate with increased mortality rate. This study aimed to examine the association between the early dynamic change of lactate levels and postoperative CRRT in ATAAD patients who received surgical repairment.MethodsThis retrospective study included 503 patients who received ATAAD surgeries. Serum lactate levels were measured before operation and at 0, 1, 3, 6, 12, 24 h post intensive care unit (ICU) admission. We examined the association between dynamic changes of lactate and CRRT.ResultsAmong all patients, 19.9% (100 patients) required CRRT. Our data showed that the lactate levels were higher in the CRRT group at all timepoints compared to the non-CRRT group. In a multivariate model, lactate levels at 12 h post ICU admission [odds ratio (OR), 1.362; p = 0.007] was identified as an independent predictor for requiring CRRT. Unsurprisingly, 30-day mortality in the CRRT group (41%) was 8.2 times higher than in the non-CRRT group (5%). To better understand the associations between CRRT and lactate levels, patients in the CRRT group were further stratified into the non-survivor group (n = 41) and survivor group (n = 59) based on the 30-day mortality. Elevated lactate levels measured upon ICU admission (OR, 1.284; p = 0.001) and decreased 24 h lactate clearance (OR, 0.237; p = 0.039) were independent risk factors for 30-day mortality in patients who received CRRT. The area under the curve to predict requirement for CRRT at 6 and 12 h post CICU admission were 0.714 and 0.722, respectively, corresponding to lactate cut-off levels of 4.15 and 2.45 mmol/L.ConclusionThe CRRT is commonly required in patients who received ATAAD surgery and often associated with worse mortality. Early dynamic changes of lactate levels can be used to predict the requirement of postoperative CRRT. |
| first_indexed | 2024-04-14T06:30:56Z |
| format | Article |
| id | doaj.art-9defe3be9c954dc49ee6548fa5c8e5d6 |
| institution | Directory Open Access Journal |
| issn | 2297-055X |
| language | English |
| last_indexed | 2024-04-14T06:30:56Z |
| publishDate | 2022-07-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Cardiovascular Medicine |
| spelling | doaj.art-9defe3be9c954dc49ee6548fa5c8e5d62022-12-22T02:07:37ZengFrontiers Media S.A.Frontiers in Cardiovascular Medicine2297-055X2022-07-01910.3389/fcvm.2022.948672948672Early dynamic behavior of lactate in predicting continuous renal replacement therapy after surgery for acute type A aortic dissectionZhigang Wang0Jingfang Xu1Yubei Kang2Ling Liu3Lifang Zhang4Dongjin Wang5Department of Cardio-Thoracic Surgery, Affiliated Drum Tower Hospital, Medical School of Nanjing University, Nanjing, ChinaDepartment of Nephrology, Nanjing Drum Tower Hospital Clinical College of Nanjing University of Chinese Medicine, Nanjing, ChinaDepartment of Cardio-Thoracic Surgery, Affiliated Drum Tower Hospital, Medical School of Nanjing University, Nanjing, ChinaDepartment of Cardio-Thoracic Surgery, Affiliated Drum Tower Hospital, Medical School of Nanjing University, Nanjing, ChinaDepartment of Psychiatry, The First Affiliated Hospital, Zhengzhou University, Zhengzhou, ChinaDepartment of Cardio-Thoracic Surgery, Affiliated Drum Tower Hospital, Medical School of Nanjing University, Nanjing, ChinaBackgroundIt has been well known that hyperlactatemia is an independent risk factor for postoperative mortality in patients who received acute type A aortic dissection (ATAAD) surgery. Some patients may require the assistance of continuous renal replacement therapy (CRRT) for acute postoperative renal deficiency and often associate with increased mortality rate. This study aimed to examine the association between the early dynamic change of lactate levels and postoperative CRRT in ATAAD patients who received surgical repairment.MethodsThis retrospective study included 503 patients who received ATAAD surgeries. Serum lactate levels were measured before operation and at 0, 1, 3, 6, 12, 24 h post intensive care unit (ICU) admission. We examined the association between dynamic changes of lactate and CRRT.ResultsAmong all patients, 19.9% (100 patients) required CRRT. Our data showed that the lactate levels were higher in the CRRT group at all timepoints compared to the non-CRRT group. In a multivariate model, lactate levels at 12 h post ICU admission [odds ratio (OR), 1.362; p = 0.007] was identified as an independent predictor for requiring CRRT. Unsurprisingly, 30-day mortality in the CRRT group (41%) was 8.2 times higher than in the non-CRRT group (5%). To better understand the associations between CRRT and lactate levels, patients in the CRRT group were further stratified into the non-survivor group (n = 41) and survivor group (n = 59) based on the 30-day mortality. Elevated lactate levels measured upon ICU admission (OR, 1.284; p = 0.001) and decreased 24 h lactate clearance (OR, 0.237; p = 0.039) were independent risk factors for 30-day mortality in patients who received CRRT. The area under the curve to predict requirement for CRRT at 6 and 12 h post CICU admission were 0.714 and 0.722, respectively, corresponding to lactate cut-off levels of 4.15 and 2.45 mmol/L.ConclusionThe CRRT is commonly required in patients who received ATAAD surgery and often associated with worse mortality. Early dynamic changes of lactate levels can be used to predict the requirement of postoperative CRRT.https://www.frontiersin.org/articles/10.3389/fcvm.2022.948672/fullaortic dissectioncontinuous renal replacement therapyperioperative lactatelactate clearancerisk factor |
| spellingShingle | Zhigang Wang Jingfang Xu Yubei Kang Ling Liu Lifang Zhang Dongjin Wang Early dynamic behavior of lactate in predicting continuous renal replacement therapy after surgery for acute type A aortic dissection Frontiers in Cardiovascular Medicine aortic dissection continuous renal replacement therapy perioperative lactate lactate clearance risk factor |
| title | Early dynamic behavior of lactate in predicting continuous renal replacement therapy after surgery for acute type A aortic dissection |
| title_full | Early dynamic behavior of lactate in predicting continuous renal replacement therapy after surgery for acute type A aortic dissection |
| title_fullStr | Early dynamic behavior of lactate in predicting continuous renal replacement therapy after surgery for acute type A aortic dissection |
| title_full_unstemmed | Early dynamic behavior of lactate in predicting continuous renal replacement therapy after surgery for acute type A aortic dissection |
| title_short | Early dynamic behavior of lactate in predicting continuous renal replacement therapy after surgery for acute type A aortic dissection |
| title_sort | early dynamic behavior of lactate in predicting continuous renal replacement therapy after surgery for acute type a aortic dissection |
| topic | aortic dissection continuous renal replacement therapy perioperative lactate lactate clearance risk factor |
| url | https://www.frontiersin.org/articles/10.3389/fcvm.2022.948672/full |
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