Min Kyu Kang1, Seung-Young Oh2,3, Hannah Lee4, Ho Geol Ryu5,4. 1. Department of Surgery, Seoul National University College of Medicine, Seoul, Korea. 2. Department of Surgery, Seoul National University College of Medicine, Seoul, Korea. faun1226@gmail.com. 3. Department of Critical Care Medicine , Seoul National University Hospital, Seoul, Korea. faun1226@gmail.com. 4. Department of Anesthesiology, Seoul National University College of Medicine, Seoul, Korea. 5. Department of Critical Care Medicine , Seoul National University Hospital, Seoul, Korea.
Abstract
BACKGROUND: This study aimed to compare the prognostic significance of pre and postoperative lactate levels and postoperative lactate clearance in the prediction of in-hospital mortality after surgery for gastrointestinal (GI) perforation. METHODS: Among patients who underwent surgery for GI perforation between 2013 and 2017, only patients whose lactate were measured before and after surgery were included and divided into an in-hospital mortality group and a survival group. Data on demographics, comorbidities, pre and postoperative laboratory test results, and operative findings were collected. Risk factors for in-hospital mortality were identified, and receiver-operating characteristic (ROC) curve analysis was performed for pre and postoperative lactate levels and postoperative lactate clearance. RESULTS: Of 104 included patients, 17 patients (16.3%) died before discharge. The in-hospital mortality group demonstrated higher preoperative lactate (6.3 ± 5.1 vs. 3.5 ± 3.2, P = 0.013), SOFA score (4.5 ± 1.7 vs. 3.4 ± 2.3, P = 0.004), proportions of patients with lymphoma (23.5% vs. 2.3%, P = 0.006), and rates of contaminated ascites (94.1% vs. 68.2%, P = 0.036) and lower preoperative hemoglobin (10.4 ± 1.6 vs. 11.8 ± 2.4, P = 0.018) compare to the survival group. Multivariate analysis revealed that postoperative lactate (HR 1.259, 95% CI 1.084-1.463, P = 0.003) and preoperative hemoglobin (HR 0.707, 95% CI 0.520-0.959, P = 0.026) affected in-hospital mortality. In the ROC curve analysis, the largest area under the curve (AUC) was shown in the postoperative lactate level (AUC = 0.771, 95% CI 0.678-0.848). CONCLUSION: Of perioperative lactate levels in patients underwent surgery for GI perforation, postoperative lactate was the strongest predictor for in-hospital mortality.
BACKGROUND: This study aimed to compare the prognostic significance of pre and postoperative lactate levels and postoperative lactate clearance in the prediction of in-hospital mortality after surgery for gastrointestinal (GI) perforation. METHODS: Among patients who underwent surgery for GI perforation between 2013 and 2017, only patients whose lactate were measured before and after surgery were included and divided into an in-hospital mortality group and a survival group. Data on demographics, comorbidities, pre and postoperative laboratory test results, and operative findings were collected. Risk factors for in-hospital mortality were identified, and receiver-operating characteristic (ROC) curve analysis was performed for pre and postoperative lactate levels and postoperative lactate clearance. RESULTS: Of 104 included patients, 17 patients (16.3%) died before discharge. The in-hospital mortality group demonstrated higher preoperative lactate (6.3 ± 5.1 vs. 3.5 ± 3.2, P = 0.013), SOFA score (4.5 ± 1.7 vs. 3.4 ± 2.3, P = 0.004), proportions of patients with lymphoma (23.5% vs. 2.3%, P = 0.006), and rates of contaminated ascites (94.1% vs. 68.2%, P = 0.036) and lower preoperative hemoglobin (10.4 ± 1.6 vs. 11.8 ± 2.4, P = 0.018) compare to the survival group. Multivariate analysis revealed that postoperative lactate (HR 1.259, 95% CI 1.084-1.463, P = 0.003) and preoperative hemoglobin (HR 0.707, 95% CI 0.520-0.959, P = 0.026) affected in-hospital mortality. In the ROC curve analysis, the largest area under the curve (AUC) was shown in the postoperative lactate level (AUC = 0.771, 95% CI 0.678-0.848). CONCLUSION: Of perioperative lactate levels in patients underwent surgery for GI perforation, postoperative lactate was the strongest predictor for in-hospital mortality.
Authors: Craig M Coopersmith; Daniel De Backer; Clifford S Deutschman; Ricard Ferrer; Ishaq Lat; Flavia R Machado; Greg S Martin; Ignacio Martin-Loeches; Mark E Nunnally; Massimo Antonelli; Laura E Evans; Judith Hellman; Sameer Jog; Jozef Kesecioglu; Mitchell M Levy; Andrew Rhodes Journal: Intensive Care Med Date: 2018-07-03 Impact factor: 17.440