.: ORİJİNAL ARAŞTIRMA
The Effect of Serum Lactate and Lactate Clearence on Mortality in Cardiac Surgery Patients
Serum Laktatı Ve Laktat Klirensinin Kalp Cerrahisi Hastalarında Mortalite Üzerine Etkisi
Turkiye Klinikleri J Cardiovasc Sci. 2019;31(3):155-61
doi: 10.5336/cardiosci.2019-70462
Makale Dili: EN
Tam Metin
ABSTRACT
Objective: Lactate levels may increase due to tissue hypoperfusion that may occur during cardiopulmonary bypass. The blood lactate level is a dynamic variable, so a single lactate measurement may not always give sufficient information about the patient. Our aim was to evaluate whether a dynamic parameter such as lactate clearance was more useful in predicting mortality and morbidity after cardiac surgery. Material and Methods: A total of 591 patients who underwent cardiovascular surgery between January 2010-September 2018 were respectively included in the study. Among patients; hemodynamic parameters, extubation durations, duration of intensive care unit stay, total duration, of hospital stay and death time of those who died within 28 days were recorded. The patients were classified into two groups:The highest lactate level <4 (Group 1) and ≥ 4 (Group 2). Among the groups; hospital and intensive care stay periods and mortality ratios were compared. 24-hour and 72-hour lactate clearances were measured in all patients. Results: Cross clamp duration (86.5±78 vs. 74.4±26.9, p=0.005) and cardiopulmonary bypass duration (122.6±38.3 vs. 112.5±36.8, p=0.002) were significantly longer in Group 2. Lactate clearance level (T1-2) at 24th hour was significantly lower in patients who do not survive compared to the patients who survive [-12.33±81.47 vs 12.56±68.94, p=0.009]. Correlation analysis revealed a weak and positive correlation between 24th hour lactate clearance and duration of hospital stay. Conclusion: The addition of dynamic lactate parameters to the evaluation, such as lactate clearance, may be useful in predicting morbidity and mortality after cardiac surgery.
Keywords: Cardiac surgery; intensive care unit; lactate; lactate clearence; mortality
Objective: Lactate levels may increase due to tissue hypoperfusion that may occur during cardiopulmonary bypass. The blood lactate level is a dynamic variable, so a single lactate measurement may not always give sufficient information about the patient. Our aim was to evaluate whether a dynamic parameter such as lactate clearance was more useful in predicting mortality and morbidity after cardiac surgery. Material and Methods: A total of 591 patients who underwent cardiovascular surgery between January 2010-September 2018 were respectively included in the study. Among patients; hemodynamic parameters, extubation durations, duration of intensive care unit stay, total duration, of hospital stay and death time of those who died within 28 days were recorded. The patients were classified into two groups:The highest lactate level <4 (Group 1) and ≥ 4 (Group 2). Among the groups; hospital and intensive care stay periods and mortality ratios were compared. 24-hour and 72-hour lactate clearances were measured in all patients. Results: Cross clamp duration (86.5±78 vs. 74.4±26.9, p=0.005) and cardiopulmonary bypass duration (122.6±38.3 vs. 112.5±36.8, p=0.002) were significantly longer in Group 2. Lactate clearance level (T1-2) at 24th hour was significantly lower in patients who do not survive compared to the patients who survive [-12.33±81.47 vs 12.56±68.94, p=0.009]. Correlation analysis revealed a weak and positive correlation between 24th hour lactate clearance and duration of hospital stay. Conclusion: The addition of dynamic lactate parameters to the evaluation, such as lactate clearance, may be useful in predicting morbidity and mortality after cardiac surgery.
Keywords: Cardiac surgery; intensive care unit; lactate; lactate clearence; mortality
ÖZET
Amaç: Kardiyopulmoner baypas sırasında meydana gelebilecek doku hipoperfüzyonu sonucu laktat seviyelerinde artış oluşabilir. Kan laktat düzeyi dinamik bir değişkendir, bu nedenle tek bir laktat ölçümü hasta hakkında her zaman yeterli bilgi vermeyebilir. Amacımız, kardiyak cerrahi sonrası mortalite ve morbidite tahmininde laktat klirensi gibi dinamik bir parametrenin daha faydalı olup olmadığını değerlendirmekti. Gereç ve Yöntemler: Ocak 2010-Eylül 2018 yılları arasında kliniğimizde kardiyovasküler cerrahi geçiren 591 hasta retrospektif olarak çalışmaya alındı. Hastalar ameliyat sonrası en yüksek laktat düzeylerine göre, laktat düzeyi<4 (Grup 1) ve≥4 (Grup 2) olmak üzere iki gruba ayrıldı. Tüm hastaların 24. saat ve 72. saat laktat klirensleri ölçüldü. Mortalite ile ilişkileri değerlendirildi. Bulgular: Grup 2'deki hastalarda Diyabetes Mellitus sıklığı (%38,9'a karşılık %30,7, p=0,038), kros klemp süresi (86,5±78'e karşılık 74,4±26,9, p=0,005) ve kardiyopulmoner baypas süresi (122,6±38,3'e karşılık 112,5±36,8, p=0,002) anlamlı olarak daha fazla idi. Hastalardan yaşamını yitirenlerde, yaşayanlara göre 24. saat laktat klirens düzeyi (T1-2) anlamlı olarak daha düşük idi [-12,33±81,47'e karşılık 12,56±68,94, p=0,009]. Yirmidördüncü saat laktat klirensi ile hastanede yatış süresi arasında zayıf ve pozitif bir korelasyon tespit edildi. Sonuç: Laktat klirensi gibi dinamik laktat parametrelerinin değerlendirmeye eklenmesi, kardiyak cerrahi sonrası morbidite ve mortalitenin öngörü değerini artırmada faydalı olabilir.
Anahtar Kelimeler: Kardiyak cerrahi; laktat; laktat klirensi; mortalite; yoğun bakım ünitesi
Amaç: Kardiyopulmoner baypas sırasında meydana gelebilecek doku hipoperfüzyonu sonucu laktat seviyelerinde artış oluşabilir. Kan laktat düzeyi dinamik bir değişkendir, bu nedenle tek bir laktat ölçümü hasta hakkında her zaman yeterli bilgi vermeyebilir. Amacımız, kardiyak cerrahi sonrası mortalite ve morbidite tahmininde laktat klirensi gibi dinamik bir parametrenin daha faydalı olup olmadığını değerlendirmekti. Gereç ve Yöntemler: Ocak 2010-Eylül 2018 yılları arasında kliniğimizde kardiyovasküler cerrahi geçiren 591 hasta retrospektif olarak çalışmaya alındı. Hastalar ameliyat sonrası en yüksek laktat düzeylerine göre, laktat düzeyi<4 (Grup 1) ve≥4 (Grup 2) olmak üzere iki gruba ayrıldı. Tüm hastaların 24. saat ve 72. saat laktat klirensleri ölçüldü. Mortalite ile ilişkileri değerlendirildi. Bulgular: Grup 2'deki hastalarda Diyabetes Mellitus sıklığı (%38,9'a karşılık %30,7, p=0,038), kros klemp süresi (86,5±78'e karşılık 74,4±26,9, p=0,005) ve kardiyopulmoner baypas süresi (122,6±38,3'e karşılık 112,5±36,8, p=0,002) anlamlı olarak daha fazla idi. Hastalardan yaşamını yitirenlerde, yaşayanlara göre 24. saat laktat klirens düzeyi (T1-2) anlamlı olarak daha düşük idi [-12,33±81,47'e karşılık 12,56±68,94, p=0,009]. Yirmidördüncü saat laktat klirensi ile hastanede yatış süresi arasında zayıf ve pozitif bir korelasyon tespit edildi. Sonuç: Laktat klirensi gibi dinamik laktat parametrelerinin değerlendirmeye eklenmesi, kardiyak cerrahi sonrası morbidite ve mortalitenin öngörü değerini artırmada faydalı olabilir.
Anahtar Kelimeler: Kardiyak cerrahi; laktat; laktat klirensi; mortalite; yoğun bakım ünitesi
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