Perioperative Hyperlactemia Is a Poor Predictor of Outcome in Patients Undergoing Surgery for Acute Type-A Aortic Dissection
(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
- Zindovic, Igor LU ; Luts, Cecilia ; Bjursten, Henrik LU ; Herou, Erik LU ; Larsson, Mårten LU ; Sjögren, Johan LU and Nozohoor, Shahab LU
- organization
- publishing date
- 2018-12
- 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}}, }