• Marco C Haanschoten, Herman G Kreeftenberg, Arthur Bouwman R R Department of Anaesthesiology, Catharina Hospital, Eindhoven, The Netherlands; Intensive Care Unit, Catharina Hospital, Eindhoven, The Netherlands., Albert H M van Straten, Wolfgang F Buhre, and Mohamed A Soliman Hamad.
• Department of Anaesthesiology, Catharina Hospital, Eindhoven, The Netherlands; Intensive Care Unit, Catharina Hospital, Eindhoven, The Netherlands.
• J. Cardiothorac. Vasc. Anesth. 2017 Feb 1; 31 (1): 45-53.

ObjectivesIn the present study, the authors investigated the predictive value of postoperative peak arterial lactate levels for early and late mortality after cardiac surgery.DesignRetrospective analysis of prospectively collected data.SettingSingle-center study in an academic hospital.ParticipantsAdult patients who underwent cardiac surgery between 2004 and 2014 (n = 16,376).InterventionsDifferent cardiac surgical procedures.Measurements And ResultsPatients were classified according to the peak arterial lactate level (PALL) within 3 days postoperatively. Logistic regression analysis and Cox regression analysis were performed to identify postoperative peak arterial lactate level as a predictor for early and late mortality respectively. In 8460 patients (51.7%), lactate was not measured postoperatively because these patients were managed according to the fast-track protocol. These patients constituted group 1 in our population but were excluded from the regression analysis. The remaining patients (n = 7,916; 48.3%) were divided according to the postoperative peak arterial lactate level (PALL): PALL<5 mmol/L (group 2), PALL 5 to 10 mmol/L (group 3), and PALL of>10 mmol/L (group 4). Early mortality was 3.7%, 20.4%, and 62.9% in groups 2, 3, and 4 respectively (p<0.0001). This mortality rate was significantly higher than that of group 1 (1.6%); p<0.0001. Multivariate regression analyses revealed postoperative peak arterial lactate as a significant predictor of 30-day mortality (odds ratio = 1.44 [1.39-1.48], p<0.001) as well as for late mortality (hazard ratio = 1.05 [1.01-1.10], p<0.025).ConclusionsPostoperative peak arterial lactate level in patients undergoing cardiac surgery is an independent predictor for both early and late mortality.Copyright © 2017 Elsevier Inc. All rights reserved.

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