Postoperative hyperlactataemia and preoperative cardiopulmonary exercise testing in an elective noncardiac surgical cohort: a retrospective observational study
Background: Blood lactate concentration in the postoperative period is a marker of physiological stress and a predictor of complications and mortality. Cardiopulmonary exercise testing (CPET) is a common preoperative risk stratification tool. We aimed to investigate the association between preoperat...
| Main Authors: | , , , |
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| Format: | Article |
| Language: | English |
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Elsevier
2023-03-01
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| Series: | BJA Open |
| Subjects: | |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S2772609623000023 |
| _version_ | 1797861108994801664 |
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| author | Christopher Darwen Angella Bryan Tanviha Quraishi-Akhtar John Moore |
| author_facet | Christopher Darwen Angella Bryan Tanviha Quraishi-Akhtar John Moore |
| author_sort | Christopher Darwen |
| collection | DOAJ |
| description | Background: Blood lactate concentration in the postoperative period is a marker of physiological stress and a predictor of complications and mortality. Cardiopulmonary exercise testing (CPET) is a common preoperative risk stratification tool. We aimed to investigate the association between preoperative CPET results and postoperative lactate concentration with postoperative mortality after major noncardiac surgery. Methods: We analysed data from patients undergoing major noncardiac surgery in a tertiary UK centre between 2007 and 2014 who had preoperative CPET and postoperative lactate measurements. Univariate and multivariate analyses were performed to assess the association between lactate concentration, CPET results, or both and mortality. Results: We analysed data from 1075 patients. A mean lactate concentration >2 mM in the first 12, 24, and 48 h after surgery was associated with odds ratios (ORs) and 95% confidence intervals (CIs) for 30-day mortality of 3.9 (2.1–7.3; P<0.005), 4.5 (2.4–8.4; P<0.005), and 6.1 (3.3–11.5; P<0.005), respectively. The dichotomous CPET variable, ventilatory equivalence for CO2 (V̇E/V̇co2; cut-off 34), was associated with increased risk of 30-day mortality (OR 2.5; 95% CI: 1.3–4.8; P<0.005). In a multivariable model, hyperlactataemia and poor V̇E/V̇co2 retained their significant associations with 30- and 90-day mortality when adjusted for age, BMI, and surgical risk. When looking at the combined effect of the dichotomous hyperlactataemia in the first 24 h (cut-off 2 mM) and preoperative V̇E/V̇co2, the OR for 30-day mortality was 11.53 (95% CI: 4.6–28.8; P≤0.005). Conclusions: Our study suggests that postoperative hyperlactataemia and preoperative poor V̇E/V̇co2 are independently associated with an increased risk of mortality after major noncardiac surgery. |
| first_indexed | 2024-04-09T21:56:45Z |
| format | Article |
| id | doaj.art-c505af7c3d104b448a09c24c10d5c4cc |
| institution | Directory Open Access Journal |
| issn | 2772-6096 |
| language | English |
| last_indexed | 2024-04-09T21:56:45Z |
| publishDate | 2023-03-01 |
| publisher | Elsevier |
| record_format | Article |
| series | BJA Open |
| spelling | doaj.art-c505af7c3d104b448a09c24c10d5c4cc2023-03-24T04:23:35ZengElsevierBJA Open2772-60962023-03-015100124Postoperative hyperlactataemia and preoperative cardiopulmonary exercise testing in an elective noncardiac surgical cohort: a retrospective observational studyChristopher Darwen0Angella Bryan1Tanviha Quraishi-Akhtar2John Moore3Manchester University NHS Foundation Trust, Manchester, UK; Corresponding author.Manchester University NHS Foundation Trust, Manchester, UK; Cardiovascular Sciences, University of Manchester, Manchester, UKManchester University NHS Foundation Trust, Manchester, UK; Cardiovascular Sciences, University of Manchester, Manchester, UKManchester University NHS Foundation Trust, Manchester, UKBackground: Blood lactate concentration in the postoperative period is a marker of physiological stress and a predictor of complications and mortality. Cardiopulmonary exercise testing (CPET) is a common preoperative risk stratification tool. We aimed to investigate the association between preoperative CPET results and postoperative lactate concentration with postoperative mortality after major noncardiac surgery. Methods: We analysed data from patients undergoing major noncardiac surgery in a tertiary UK centre between 2007 and 2014 who had preoperative CPET and postoperative lactate measurements. Univariate and multivariate analyses were performed to assess the association between lactate concentration, CPET results, or both and mortality. Results: We analysed data from 1075 patients. A mean lactate concentration >2 mM in the first 12, 24, and 48 h after surgery was associated with odds ratios (ORs) and 95% confidence intervals (CIs) for 30-day mortality of 3.9 (2.1–7.3; P<0.005), 4.5 (2.4–8.4; P<0.005), and 6.1 (3.3–11.5; P<0.005), respectively. The dichotomous CPET variable, ventilatory equivalence for CO2 (V̇E/V̇co2; cut-off 34), was associated with increased risk of 30-day mortality (OR 2.5; 95% CI: 1.3–4.8; P<0.005). In a multivariable model, hyperlactataemia and poor V̇E/V̇co2 retained their significant associations with 30- and 90-day mortality when adjusted for age, BMI, and surgical risk. When looking at the combined effect of the dichotomous hyperlactataemia in the first 24 h (cut-off 2 mM) and preoperative V̇E/V̇co2, the OR for 30-day mortality was 11.53 (95% CI: 4.6–28.8; P≤0.005). Conclusions: Our study suggests that postoperative hyperlactataemia and preoperative poor V̇E/V̇co2 are independently associated with an increased risk of mortality after major noncardiac surgery.http://www.sciencedirect.com/science/article/pii/S2772609623000023CPETCPEXhyperlactataemialactatemortalityperioperative |
| spellingShingle | Christopher Darwen Angella Bryan Tanviha Quraishi-Akhtar John Moore Postoperative hyperlactataemia and preoperative cardiopulmonary exercise testing in an elective noncardiac surgical cohort: a retrospective observational study BJA Open CPET CPEX hyperlactataemia lactate mortality perioperative |
| title | Postoperative hyperlactataemia and preoperative cardiopulmonary exercise testing in an elective noncardiac surgical cohort: a retrospective observational study |
| title_full | Postoperative hyperlactataemia and preoperative cardiopulmonary exercise testing in an elective noncardiac surgical cohort: a retrospective observational study |
| title_fullStr | Postoperative hyperlactataemia and preoperative cardiopulmonary exercise testing in an elective noncardiac surgical cohort: a retrospective observational study |
| title_full_unstemmed | Postoperative hyperlactataemia and preoperative cardiopulmonary exercise testing in an elective noncardiac surgical cohort: a retrospective observational study |
| title_short | Postoperative hyperlactataemia and preoperative cardiopulmonary exercise testing in an elective noncardiac surgical cohort: a retrospective observational study |
| title_sort | postoperative hyperlactataemia and preoperative cardiopulmonary exercise testing in an elective noncardiac surgical cohort a retrospective observational study |
| topic | CPET CPEX hyperlactataemia lactate mortality perioperative |
| url | http://www.sciencedirect.com/science/article/pii/S2772609623000023 |
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