Key result
A serum lactate level > 1.1 mmol/L in the first 24 hours post-operation was the strongest predictor for developing renal failure in cardiac surgery patients with normal pre-operative renal function.
Observational (n=1,574)
Elevated serum lactate (> 1.1 mmol/L) in the first 24 hours post-cardiac surgery is a strong predictor of acute renal failure requiring renal replacement therapy in patients with normal baseline renal function.
May flag high-risk patients for closer renal surveillance post-cardiac surgery; hypothesis-generating from observational data and needs prospective validation.
Peri-operative acute renal failure requiring renal replacement therapy is common (5-30%) after cardiac surgery and associated with a mortality of approximately 50%. Pre-operative renal impairment seems to be the most important risk factor for frank postoperative renal failure. To help evaluate the risk factors, we conducted a prospective observational trial of 1574 consecutive patients with normal pre-operative renal function (creatinine < 110 micromol.l(-1)). Renal failure was defined as the need for renal replacement therapy. After univariate analysis of previously described risk factors, those who differed significantly between patients with or without renal failure were enrolled into a multivariate classification and regression tree (CART) statistical model that identifies the most 'predictive' risk factors and creates a ranked list of these. In patients with pre-operatively normal renal function, a serum level of lactate > 1.1 mmol.l(-1) in the first 24 h after the operation was the strongest predictor for the development of renal failure.
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Hauer et al. (2009) conducted an observational in Cardiac surgery (n=1,574). Serum level of lactate > 1.1 mmol.l(-1) in the first 24 h post-operation was evaluated on Development of renal failure (need for renal replacement therapy). A serum lactate level > 1.1 mmol/L in the first 24 hours post-operation was the strongest predictor for developing renal failure in cardiac surgery patients with normal pre-operative renal function.
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