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Admission lactate and outcome after high-risk surgery

Introduction

The aim of this study was to assess the ability of serum lactate level in patients admitted to the ICU after surgery to predict outcome.

Methods

A retrospective, clinical observational study in patients undergoing high-risk surgery admitted to a 17-bed ICU of a large teaching hospital. Data were obtained during haemodynamic optimization using an established GDT protocol in the first 8 hours after admission and included demographic data as well as haemodynamic and laboratory parameters. Outcome data included morbidity (defined as >1 complications on the postoperative morbidity survey) and clinical outcome (hospital mortality, length of ICU stay, length of hospital stay, readmission to the ICU).

Results

Sixty-seven patients were included. Lactate clearance (decrease of lactate >10% in 2 hours) occurred in 64 patients (96%). Sixty patients developed at least one surgical complication. There were no significant correlation between lactate levels on admission and development of complications and length of hospital stay. Nine patients (13%) were readmitted to the ICU. A receiving operator characteristic analysis for readmission to the ICU showed an area under the curve of 0.79. A lactate higher than 1.7 mmol/l on admission had a sensitivity of 75% and a specificity of 74% to predict ICU readmission (Figure 1). Patients with a lactate on admission >1.7 mmol/l also had a longer length of ICU stay (Table 1).

Figure 1
figure1

Prediction of ICU readmission according to initial lactate concentration.

Table 1 Lactate on admission, complications and clinical outcome

Conclusion

Lactate on admission correlates with length of ICU stay and readmission to the ICU.

References

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Correspondence to M Geisen.

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Geisen, M., Aya, H., Ebm, C. et al. Admission lactate and outcome after high-risk surgery. Crit Care 16, P261 (2012). https://doi.org/10.1186/cc10868

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Keywords

  • Lactate
  • Receive Operator Characteristic
  • Hospital Mortality
  • Postoperative Morbidity
  • Lactate Level