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Perioperative Hyperlactemia Is a Poor Predictor of Outcome in Patients Undergoing Surgery for Acute Type-A Aortic Dissection

Zindovic, Igor LU ; Luts, Cecilia ; Bjursten, Henrik LU ; Herou, Erik LU orcid ; Larsson, Mårten LU ; Sjögren, Johan LU and Nozohoor, Shahab LU (2018) In Journal of Cardiothoracic and Vascular Anesthesia 32(6). p.2479-2484
Abstract

Objective: In patients presenting with acute type-A aortic dissection (aTAAD), lactic acid measurement is a frequently used analysis for diagnosis of acute ischemia, which may have a dismal prognosis. The aim of the current study was to determine the performance of perioperative arterial lactic acid measurements in predicting outcome in aTAAD patients. Design: Retrospective, observational study. Setting: Cardiothoracic surgery unit at a tertiary-level hospital. Participants: The study involved 285 consecutive patients undergoing surgery for aTAAD. Interventions: Preoperative and postoperative lactic acid levels were measured and evaluated together with clinical data related to outcome, including in-hospital and 1-year mortality.... (More)

Objective: In patients presenting with acute type-A aortic dissection (aTAAD), lactic acid measurement is a frequently used analysis for diagnosis of acute ischemia, which may have a dismal prognosis. The aim of the current study was to determine the performance of perioperative arterial lactic acid measurements in predicting outcome in aTAAD patients. Design: Retrospective, observational study. Setting: Cardiothoracic surgery unit at a tertiary-level hospital. Participants: The study involved 285 consecutive patients undergoing surgery for aTAAD. Interventions: Preoperative and postoperative lactic acid levels were measured and evaluated together with clinical data related to outcome, including in-hospital and 1-year mortality. Measurements and Main Results: Altogether, 37 patients (13%) died during the index hospital admission, and survival was 84.4 ± 2.2 at 1 year. Preoperative cardiac malperfusion (odds ratio [OR] 3.1; 95% confidence interval [CI] 1.3-7.3) and cerebral malperfusion (OR 2.6; 95% CI 1.2-5.6) were associated significantly with poorer 1-year survival. The area under the curve (AUC) for in-hospital and 1-year mortality in relation to preoperative lactic acid levels was 0.684 and 0.673, respectively, corresponding to a lactic acid cut-off for in-hospital mortality of 2.75 mmol/L (sensitivity 56%; specificity 72%) and a cut-off for 1-year mortality of 2.85 mmol/L (sensitivity 48%; specificity 74%). The AUC for in-hospital and 1-year mortality in relation to lactic acid levels measured postoperatively on arrival at the intensive care unit was 0.582 and 0.498, respectively. Conclusion: Although hyperlactemia in aTAAD indicates an increased risk of postoperative mortality, the sole use of lactic acid levels as a tool for accurate assessment of postoperative mortality is inadvisable due to its poor discriminatory performance.

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author
; ; ; ; ; and
organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
aneurysm, dissecting, lactic acid, malperfusion, outcome
in
Journal of Cardiothoracic and Vascular Anesthesia
volume
32
issue
6
pages
2479 - 2484
publisher
Elsevier
external identifiers
  • pmid:29699847
  • scopus:85046116375
ISSN
1053-0770
DOI
10.1053/j.jvca.2018.03.030
language
English
LU publication?
yes
id
cc9f9eaf-3bda-473f-9289-f799e3e8c411
date added to LUP
2018-05-15 14:32:12
date last changed
2024-03-18 09:32:35
@article{cc9f9eaf-3bda-473f-9289-f799e3e8c411,
  abstract     = {{<p>Objective: In patients presenting with acute type-A aortic dissection (aTAAD), lactic acid measurement is a frequently used analysis for diagnosis of acute ischemia, which may have a dismal prognosis. The aim of the current study was to determine the performance of perioperative arterial lactic acid measurements in predicting outcome in aTAAD patients. Design: Retrospective, observational study. Setting: Cardiothoracic surgery unit at a tertiary-level hospital. Participants: The study involved 285 consecutive patients undergoing surgery for aTAAD. Interventions: Preoperative and postoperative lactic acid levels were measured and evaluated together with clinical data related to outcome, including in-hospital and 1-year mortality. Measurements and Main Results: Altogether, 37 patients (13%) died during the index hospital admission, and survival was 84.4 ± 2.2 at 1 year. Preoperative cardiac malperfusion (odds ratio [OR] 3.1; 95% confidence interval [CI] 1.3-7.3) and cerebral malperfusion (OR 2.6; 95% CI 1.2-5.6) were associated significantly with poorer 1-year survival. The area under the curve (AUC) for in-hospital and 1-year mortality in relation to preoperative lactic acid levels was 0.684 and 0.673, respectively, corresponding to a lactic acid cut-off for in-hospital mortality of 2.75 mmol/L (sensitivity 56%; specificity 72%) and a cut-off for 1-year mortality of 2.85 mmol/L (sensitivity 48%; specificity 74%). The AUC for in-hospital and 1-year mortality in relation to lactic acid levels measured postoperatively on arrival at the intensive care unit was 0.582 and 0.498, respectively. Conclusion: Although hyperlactemia in aTAAD indicates an increased risk of postoperative mortality, the sole use of lactic acid levels as a tool for accurate assessment of postoperative mortality is inadvisable due to its poor discriminatory performance.</p>}},
  author       = {{Zindovic, Igor and Luts, Cecilia and Bjursten, Henrik and Herou, Erik and Larsson, Mårten and Sjögren, Johan and Nozohoor, Shahab}},
  issn         = {{1053-0770}},
  keywords     = {{aneurysm, dissecting; lactic acid; malperfusion; outcome}},
  language     = {{eng}},
  number       = {{6}},
  pages        = {{2479--2484}},
  publisher    = {{Elsevier}},
  series       = {{Journal of Cardiothoracic and Vascular Anesthesia}},
  title        = {{Perioperative Hyperlactemia Is a Poor Predictor of Outcome in Patients Undergoing Surgery for Acute Type-A Aortic Dissection}},
  url          = {{http://dx.doi.org/10.1053/j.jvca.2018.03.030}},
  doi          = {{10.1053/j.jvca.2018.03.030}},
  volume       = {{32}},
  year         = {{2018}},
}