Key result
Each 1 mmol/l increase in peak lactate level on postoperative days 0 to 3 was associated with increased 90-day mortality in surgical ICU patients (HR 1.15; 95% CI 1.11-1.19; P<0.001).
Why the study?
There was inadequate information on the association of pre-operative and postoperative peak lactate levels with mortality in surgical ICU patients.
Does peri-operative serum lactate level predict 90-day mortality in adult patients postoperatively admitted to the surgical ICU?
Cohort (n=9,248)
No
Does peri-operative serum lactate level predict 90-day mortality in adult patients postoperatively admitted to the surgical ICU?
Hazard Ratio: 1.15 (95% CI 1.11–1.19)
p-value: p=< 0.001
Higher peak serum lactate levels during postoperative days 0 to 3 are significantly associated with increased 90-day mortality in surgical ICU patients.
May inform postoperative risk stratification in surgical ICU patients; leaves open whether lactate-targeted interventions improve survival.
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. INTERVENTION: None. 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 1 mmol l, 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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Oh et al. (2020) conducted a cohort in Postoperative surgical ICU admission (n=9,248). Peak lactate level on postoperative days 0 to 3 vs. Per 1 mmol/l increase was evaluated on 90-day mortality (HR 1.15, 95% CI 1.11 to 1.19, p=< 0.001). Each 1 mmol/l increase in peak lactate level on postoperative days 0 to 3 was associated with increased 90-day mortality in surgical ICU patients (HR 1.15; 95% CI 1.11-1.19; P<0.001).
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