Key result
Postoperative 48-hour lactate strongly predicts ICU mortality after tetralogy of Fallot repair with ~97% AUC.
Why the study?
There is little published literature evaluating the utility of serum lactate, base excess, and oxygen partial pressure as prognostic markers in patients undergoing surgical repair of tetralogy of Fallot.
Do arterial blood gas biomarkers (lactate, base excess, PO2) predict ICU mortality in patients undergoing surgical repair of tetralogy of Fallot?
Observational (n=150)
Do arterial blood gas biomarkers (lactate, base excess, PO2) predict ICU mortality in patients undergoing surgical repair of tetralogy of Fallot?
Effect estimate: AUC 96.9%
p-value: p=<0.001
Serum lactate and base excess are strong, simple, and cost-effective prognostic markers for predicting ICU mortality in patients undergoing tetralogy of Fallot repair.
May support 48-hour lactate for mortality risk stratification after tetralogy repair; hypothesis-generating pending prospective validation.
BACKGROUND: Serum lactate and base deficit have been shown to be a predictor of morbidity and mortality in critically ill patients. Poor preoperative oxygenation appears to be one of the significant factors that affects early mortality in tetralogy of Fallot (TOF). There is little published literature evaluating the utility of serum lactate, base excess (BE), and oxygen partial pressure (PO 2 ) as simple, widely available, prognostic markers in patients undergoing surgical repair of TOF. MATERIALS AND METHODS: This prospective, observational study was conducted in 150 TOF patients, undergoing elective intracardiac repair. PO 2 , BE, and lactate levels at three different time intervals were recorded. Arterial blood samples were collected after induction (T1), after cardiopulmonary bypass (T2), and 48 h (T3) after surgery in the Intensive Care Unit (ICU). To observe the changes in PO 2 , BE, and lactate levels over a period of time, repeated measures analysis was performed with Bonferroni method. The receiver operating characteristics (ROC) analysis was used to find area under curve (AUC) and cutoff values of various biomarkers for predicting mortality in ICU. RESULTS: The patients who could not survive showed significant elevated lactate levels at baseline (T1) and postoperatively (T2) as compared to patients who survived after surgery (P < 0.001). However, in nonsurvivors, the BE value decreased significantly in the postoperative period in comparison to survivors (-2.8 ± 4.27 vs. 5.04 ± 2.06) (P < 0.001). In nonsurvivors, there was a significant fall of PO 2 to a mean value of 59.86 ± 15.09 in ICU (T3), whereas those who survived had a PO 2 of 125.86 ± 95.09 (P < 0.001). The ROC curve analysis showed that lactate levels (T3) have highest mortality predictive value (AUC: 96.9%) as compared to BE (AUC: 94.5%) and PO 2 (AUC: 81.1%). CONCLUSION: Serum lactate and BE may be used as prognostic markers to predict mortality in patients undergoing TOF repair. The routine analysis of these simple, fast, widely available, and cost-effective biomarkers should be encouraged to predict prognosis of TOF patients.
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Bhardwaj et al. (2017) conducted an observational in Tetralogy of Fallot (TOF) (n=150). Arterial blood gas biomarkers (lactate, base excess, PO2) was evaluated on Mortality in ICU (AUC 96.9%, p=<0.001).
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