Peri-operative serum lactate level and postoperative 90-day mortality in a surgical ICU: A retrospective association study

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Abstract

BACKGROUND There is inadequate information on the association of pre-operative and postoperative peak level of lactate with mortality of surgical ICU patients. OBJECTIVE To investigate the association between peri-operative lactate level and 90-day mortality in patients admtted to the surgical ICU. DESIGN Retrospective cohort study. SETTING ICUs in single tertiary academic hospital. PATIENTS Adult patients postoperatively admitted to the ICU between January 2012 and December 2017.INTERVENTIONNone. MAIN OUTCOME MEASURES Hazard ratios of 90-day mortality according to the following serum lactate levels were assessed: pre-operative lactate level; peak lactate levels on postoperative day (POD) 0 to 3; and delta values of the lactate level on POD 0 to 3 from pre-operative lactate level. Multivariable Cox regression and receiver operating characteristic analyses were used. RESULTS Overall 9248 patients were included, among whom 2511, 8690 and 1958 had measured pre-operative lactate levels, lactate levels within POD 0 to 3, and lactate levels measured at both timepoints, respectively. When the peak lactate level on POD 0 to 3 and delta lactate level all increased by 1mmoll-1, 90-day mortality increased by 15% [hazard ratio: 1.15; 95% confidence interval (CI) 1.11 to 1.19; P<0.001] and 14% (hazard ratio: 1.14; 95% CI 1.11 to 1.18; P<0.001), respectively; the pre-operative lactate level was not significantly associated with 90-day mortality (P=0.069). The area under the curve for peak level of lactate on POD 0 to 3 (0.72, 95% CI 0.70 to 0.74) was higher than that of pre-operative lactate level (0.58, 95% CI 0.56 to 0.60) in the receiver operating characteristic analysis. CONCLUSION In patients admitted postoperatively to the ICU, higher peri-operative lactate levels were associated with increased 90-day mortality. The peak level of lactate during POD 0 to 3 showed the most significant contribution to this association.

Original languageEnglish
Pages (from-to)31-37
Number of pages7
JournalEuropean Journal of Anaesthesiology
Volume37
Issue number1
DOIs
StatePublished - 1 Jan 2020

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Lactic Acid
Retrospective Studies
Mortality
Serum
Confidence Intervals
ROC Curve
Tertiary Care Centers
Area Under Curve
Cohort Studies

Cite this

@article{3219c7728b0f43d3843e42a5f4ed92a3,
title = "Peri-operative serum lactate level and postoperative 90-day mortality in a surgical ICU: A retrospective association study",
abstract = "BACKGROUND There is inadequate information on the association of pre-operative and postoperative peak level of lactate with mortality of surgical ICU patients. OBJECTIVE To investigate the association between peri-operative lactate level and 90-day mortality in patients admtted to the surgical ICU. DESIGN Retrospective cohort study. SETTING ICUs in single tertiary academic hospital. PATIENTS Adult patients postoperatively admitted to the ICU between January 2012 and December 2017.INTERVENTIONNone. MAIN OUTCOME MEASURES Hazard ratios of 90-day mortality according to the following serum lactate levels were assessed: pre-operative lactate level; peak lactate levels on postoperative day (POD) 0 to 3; and delta values of the lactate level on POD 0 to 3 from pre-operative lactate level. Multivariable Cox regression and receiver operating characteristic analyses were used. RESULTS Overall 9248 patients were included, among whom 2511, 8690 and 1958 had measured pre-operative lactate levels, lactate levels within POD 0 to 3, and lactate levels measured at both timepoints, respectively. When the peak lactate level on POD 0 to 3 and delta lactate level all increased by 1mmoll-1, 90-day mortality increased by 15{\%} [hazard ratio: 1.15; 95{\%} confidence interval (CI) 1.11 to 1.19; P<0.001] and 14{\%} (hazard ratio: 1.14; 95{\%} CI 1.11 to 1.18; P<0.001), respectively; the pre-operative lactate level was not significantly associated with 90-day mortality (P=0.069). The area under the curve for peak level of lactate on POD 0 to 3 (0.72, 95{\%} CI 0.70 to 0.74) was higher than that of pre-operative lactate level (0.58, 95{\%} CI 0.56 to 0.60) in the receiver operating characteristic analysis. CONCLUSION In patients admitted postoperatively to the ICU, higher peri-operative lactate levels were associated with increased 90-day mortality. The peak level of lactate during POD 0 to 3 showed the most significant contribution to this association.",
author = "Oh, {Tak Kyu} and Song, {In Ae} and Jeon, {Young Tae}",
year = "2020",
month = "1",
day = "1",
doi = "10.1097/EJA.0000000000001117",
language = "English",
volume = "37",
pages = "31--37",
journal = "European journal of anaesthesiology",
issn = "0265-0215",
publisher = "Wolters Kluwer Health",
number = "1",

}

TY - JOUR

T1 - Peri-operative serum lactate level and postoperative 90-day mortality in a surgical ICU

T2 - A retrospective association study

AU - Oh, Tak Kyu

AU - Song, In Ae

AU - Jeon, Young Tae

PY - 2020/1/1

Y1 - 2020/1/1

N2 - BACKGROUND There is inadequate information on the association of pre-operative and postoperative peak level of lactate with mortality of surgical ICU patients. OBJECTIVE To investigate the association between peri-operative lactate level and 90-day mortality in patients admtted to the surgical ICU. DESIGN Retrospective cohort study. SETTING ICUs in single tertiary academic hospital. PATIENTS Adult patients postoperatively admitted to the ICU between January 2012 and December 2017.INTERVENTIONNone. MAIN OUTCOME MEASURES Hazard ratios of 90-day mortality according to the following serum lactate levels were assessed: pre-operative lactate level; peak lactate levels on postoperative day (POD) 0 to 3; and delta values of the lactate level on POD 0 to 3 from pre-operative lactate level. Multivariable Cox regression and receiver operating characteristic analyses were used. RESULTS Overall 9248 patients were included, among whom 2511, 8690 and 1958 had measured pre-operative lactate levels, lactate levels within POD 0 to 3, and lactate levels measured at both timepoints, respectively. When the peak lactate level on POD 0 to 3 and delta lactate level all increased by 1mmoll-1, 90-day mortality increased by 15% [hazard ratio: 1.15; 95% confidence interval (CI) 1.11 to 1.19; P<0.001] and 14% (hazard ratio: 1.14; 95% CI 1.11 to 1.18; P<0.001), respectively; the pre-operative lactate level was not significantly associated with 90-day mortality (P=0.069). The area under the curve for peak level of lactate on POD 0 to 3 (0.72, 95% CI 0.70 to 0.74) was higher than that of pre-operative lactate level (0.58, 95% CI 0.56 to 0.60) in the receiver operating characteristic analysis. CONCLUSION In patients admitted postoperatively to the ICU, higher peri-operative lactate levels were associated with increased 90-day mortality. The peak level of lactate during POD 0 to 3 showed the most significant contribution to this association.

AB - BACKGROUND There is inadequate information on the association of pre-operative and postoperative peak level of lactate with mortality of surgical ICU patients. OBJECTIVE To investigate the association between peri-operative lactate level and 90-day mortality in patients admtted to the surgical ICU. DESIGN Retrospective cohort study. SETTING ICUs in single tertiary academic hospital. PATIENTS Adult patients postoperatively admitted to the ICU between January 2012 and December 2017.INTERVENTIONNone. MAIN OUTCOME MEASURES Hazard ratios of 90-day mortality according to the following serum lactate levels were assessed: pre-operative lactate level; peak lactate levels on postoperative day (POD) 0 to 3; and delta values of the lactate level on POD 0 to 3 from pre-operative lactate level. Multivariable Cox regression and receiver operating characteristic analyses were used. RESULTS Overall 9248 patients were included, among whom 2511, 8690 and 1958 had measured pre-operative lactate levels, lactate levels within POD 0 to 3, and lactate levels measured at both timepoints, respectively. When the peak lactate level on POD 0 to 3 and delta lactate level all increased by 1mmoll-1, 90-day mortality increased by 15% [hazard ratio: 1.15; 95% confidence interval (CI) 1.11 to 1.19; P<0.001] and 14% (hazard ratio: 1.14; 95% CI 1.11 to 1.18; P<0.001), respectively; the pre-operative lactate level was not significantly associated with 90-day mortality (P=0.069). The area under the curve for peak level of lactate on POD 0 to 3 (0.72, 95% CI 0.70 to 0.74) was higher than that of pre-operative lactate level (0.58, 95% CI 0.56 to 0.60) in the receiver operating characteristic analysis. CONCLUSION In patients admitted postoperatively to the ICU, higher peri-operative lactate levels were associated with increased 90-day mortality. The peak level of lactate during POD 0 to 3 showed the most significant contribution to this association.

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U2 - 10.1097/EJA.0000000000001117

DO - 10.1097/EJA.0000000000001117

M3 - Article

C2 - 31724965

AN - SCOPUS:85076061241

VL - 37

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JO - European journal of anaesthesiology

JF - European journal of anaesthesiology

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