Rate of increase in serum lactate level risk-stratifies infants after surgery for congenital heart disease
Objective Increased blood lactate levels reflect tissue oxygen debt and might be indicative of low cardiac output. We hypothesized that the rate of increase in serum lactate would be an ideal marker to discriminate between infants at high and low risk of a poor outcome after surgical repair of conge...
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| Veröffentlicht in: | The Journal of thoracic and cardiovascular surgery 2014-08, Vol.148 (2), p.589-595 |
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| creator | Schumacher, Kurt R., MS, MD Reichel, Rebecca A., BS Vlasic, Jeffrey R., MS Yu, Sunkyung, MS Donohue, Janet, MPH Gajarski, Robert J., MD Charpie, John R., MD, PhD |
| description | Objective Increased blood lactate levels reflect tissue oxygen debt and might be indicative of low cardiac output. We hypothesized that the rate of increase in serum lactate would be an ideal marker to discriminate between infants at high and low risk of a poor outcome after surgical repair of congenital heart disease using cardiopulmonary bypass. Methods In the present prospective, observational study in a pediatric cardiac intensive care unit, infants (aged |
| doi_str_mv | 10.1016/j.jtcvs.2013.09.002 |
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We hypothesized that the rate of increase in serum lactate would be an ideal marker to discriminate between infants at high and low risk of a poor outcome after surgical repair of congenital heart disease using cardiopulmonary bypass. Methods In the present prospective, observational study in a pediatric cardiac intensive care unit, infants (aged <12 months) undergoing cardiac surgery had serial whole blood lactate levels measured with every arterial blood gas drawn for the first 24 postoperative hours. The composite poor outcome included death, the need for extracorporeal support, and dialysis. Results The lactate levels were measured in 231 infants; 19 infants (8.2%) had a poor outcome. A lactate increase rate of 0.6 mmol/L/h had very good discriminatory ability (area under the curve [AUC], 0.89) with a sensitivity of 90%, specificity of 84%, positive predictive value (PPV) of 34%, and negative predictive value (NPV) of 99%. Similar results were obtained for subgroups stratified by 1- or 2-ventricle heart disease and risk adjustment for congenital heart surgery (RACHS-1) score. In neonates (age <30 days) with single-ventricle physiology (n = 43, poor outcome = 8), a lactate increase of 0.6 mmol/L/h had near perfect discriminatory ability (AUC 0.99) with a sensitivity of 100%, specificity of 51%, PPV of 32%, and NPV of 100%. In 2-ventricle neonates (n = 43, poor outcome = 5), a lactate increase of 0.6 mmol/L/h also had near perfect discriminatory ability (AUC, 0.99), with a sensitivity of 100%, specificity of 90%, PPV of 56%, and NPV of 100%. Conclusions The postoperative lactate increase rate allows discrimination between infants at high and low risk of morbidity and mortality after congenital heart disease surgery, and the lactate level can be followed serially for the treatment response.</description><identifier>ISSN: 0022-5223</identifier><identifier>EISSN: 1097-685X</identifier><identifier>DOI: 10.1016/j.jtcvs.2013.09.002</identifier><identifier>PMID: 24138790</identifier><language>eng</language><publisher>United States: Mosby, Inc</publisher><subject>Acidosis, Lactic - blood ; Acidosis, Lactic - diagnosis ; Acidosis, Lactic - etiology ; Acidosis, Lactic - mortality ; Age Factors ; Area Under Curve ; Biomarkers - blood ; Cardiac Surgical Procedures - adverse effects ; Cardiac Surgical Procedures - mortality ; Cardiopulmonary Bypass ; Cardiothoracic Surgery ; Female ; Heart Defects, Congenital - blood ; Heart Defects, Congenital - diagnosis ; Heart Defects, Congenital - mortality ; Heart Defects, Congenital - surgery ; Humans ; Infant ; Infant, Newborn ; Intensive Care Units, Pediatric ; Lactic Acid - blood ; Male ; Predictive Value of Tests ; Prospective Studies ; Risk Assessment ; Risk Factors ; ROC Curve ; Time Factors ; Treatment Outcome ; Up-Regulation</subject><ispartof>The Journal of thoracic and cardiovascular surgery, 2014-08, Vol.148 (2), p.589-595</ispartof><rights>The American Association for Thoracic Surgery</rights><rights>2014 The American Association for Thoracic Surgery</rights><rights>Copyright © 2014 The American Association for Thoracic Surgery. Published by Mosby, Inc. All rights reserved.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c595t-198ace1e837b91f94e5ff6052cec8d588ee9a1c1c95351452963306b1137f7923</citedby><cites>FETCH-LOGICAL-c595t-198ace1e837b91f94e5ff6052cec8d588ee9a1c1c95351452963306b1137f7923</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://www.sciencedirect.com/science/article/pii/S0022522313009951$$EHTML$$P50$$Gelsevier$$Hfree_for_read</linktohtml><link.rule.ids>314,776,780,3537,27901,27902,65306</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/24138790$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Schumacher, Kurt R., MS, MD</creatorcontrib><creatorcontrib>Reichel, Rebecca A., BS</creatorcontrib><creatorcontrib>Vlasic, Jeffrey R., MS</creatorcontrib><creatorcontrib>Yu, Sunkyung, MS</creatorcontrib><creatorcontrib>Donohue, Janet, MPH</creatorcontrib><creatorcontrib>Gajarski, Robert J., MD</creatorcontrib><creatorcontrib>Charpie, John R., MD, PhD</creatorcontrib><title>Rate of increase in serum lactate level risk-stratifies infants after surgery for congenital heart disease</title><title>The Journal of thoracic and cardiovascular surgery</title><addtitle>J Thorac Cardiovasc Surg</addtitle><description>Objective Increased blood lactate levels reflect tissue oxygen debt and might be indicative of low cardiac output. We hypothesized that the rate of increase in serum lactate would be an ideal marker to discriminate between infants at high and low risk of a poor outcome after surgical repair of congenital heart disease using cardiopulmonary bypass. Methods In the present prospective, observational study in a pediatric cardiac intensive care unit, infants (aged <12 months) undergoing cardiac surgery had serial whole blood lactate levels measured with every arterial blood gas drawn for the first 24 postoperative hours. The composite poor outcome included death, the need for extracorporeal support, and dialysis. Results The lactate levels were measured in 231 infants; 19 infants (8.2%) had a poor outcome. A lactate increase rate of 0.6 mmol/L/h had very good discriminatory ability (area under the curve [AUC], 0.89) with a sensitivity of 90%, specificity of 84%, positive predictive value (PPV) of 34%, and negative predictive value (NPV) of 99%. Similar results were obtained for subgroups stratified by 1- or 2-ventricle heart disease and risk adjustment for congenital heart surgery (RACHS-1) score. In neonates (age <30 days) with single-ventricle physiology (n = 43, poor outcome = 8), a lactate increase of 0.6 mmol/L/h had near perfect discriminatory ability (AUC 0.99) with a sensitivity of 100%, specificity of 51%, PPV of 32%, and NPV of 100%. In 2-ventricle neonates (n = 43, poor outcome = 5), a lactate increase of 0.6 mmol/L/h also had near perfect discriminatory ability (AUC, 0.99), with a sensitivity of 100%, specificity of 90%, PPV of 56%, and NPV of 100%. Conclusions The postoperative lactate increase rate allows discrimination between infants at high and low risk of morbidity and mortality after congenital heart disease surgery, and the lactate level can be followed serially for the treatment response.</description><subject>Acidosis, Lactic - blood</subject><subject>Acidosis, Lactic - diagnosis</subject><subject>Acidosis, Lactic - etiology</subject><subject>Acidosis, Lactic - mortality</subject><subject>Age Factors</subject><subject>Area Under Curve</subject><subject>Biomarkers - blood</subject><subject>Cardiac Surgical Procedures - adverse effects</subject><subject>Cardiac Surgical Procedures - mortality</subject><subject>Cardiopulmonary Bypass</subject><subject>Cardiothoracic Surgery</subject><subject>Female</subject><subject>Heart Defects, Congenital - blood</subject><subject>Heart Defects, Congenital - diagnosis</subject><subject>Heart Defects, Congenital - mortality</subject><subject>Heart Defects, Congenital - surgery</subject><subject>Humans</subject><subject>Infant</subject><subject>Infant, Newborn</subject><subject>Intensive Care Units, Pediatric</subject><subject>Lactic Acid - blood</subject><subject>Male</subject><subject>Predictive Value of Tests</subject><subject>Prospective Studies</subject><subject>Risk Assessment</subject><subject>Risk Factors</subject><subject>ROC Curve</subject><subject>Time Factors</subject><subject>Treatment Outcome</subject><subject>Up-Regulation</subject><issn>0022-5223</issn><issn>1097-685X</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2014</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNqFkU1v1DAQhi0EotvCL0BCPnJJ8NjrJD6AhKpCkSoh8SFxs7zOuDjNJsXjrLT_HoctHLhwsmU_74zmGcZegKhBQPN6qIfsD1RLAaoWphZCPmIbEKatmk5_f8w25UVWWkp1xs6JBiFEK8A8ZWdyC6prjdiw4bPLyOfA4-QTOsJy4YRp2fPR-bx-jnjAkadIdxXl5HIMEalgwU2ZuAsZE6cl3WI68jAn7ufpFqeY3ch_oEuZ95HWys_Yk-BGwucP5wX79v7q6-V1dfPpw8fLdzeV10bnCkznPAJ2qt0ZCGaLOoRGaOnRd73uOkTjwIM3WmnYamkapUSzA1BtaI1UF-zVqe59mn8uSNnuI3kcRzfhvJAFvW0kNMZ0BVUn1KeZKGGw9ynuXTpaEHaVbAf7W7JdJVthbFFaUi8fGiy7PfZ_M3-sFuDNCcAy5iFisuQjTh77mNBn28_xPw3e_pP3Y5yid-MdHpGGeUlTMWjBkrTCfln3vK4ZlBDGaFC_AIQ8pGo</recordid><startdate>20140801</startdate><enddate>20140801</enddate><creator>Schumacher, Kurt R., MS, MD</creator><creator>Reichel, Rebecca A., BS</creator><creator>Vlasic, Jeffrey R., MS</creator><creator>Yu, Sunkyung, MS</creator><creator>Donohue, Janet, MPH</creator><creator>Gajarski, Robert J., MD</creator><creator>Charpie, John R., MD, PhD</creator><general>Mosby, Inc</general><scope>6I.</scope><scope>AAFTH</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>20140801</creationdate><title>Rate of increase in serum lactate level risk-stratifies infants after surgery for congenital heart disease</title><author>Schumacher, Kurt R., MS, MD ; Reichel, Rebecca A., BS ; Vlasic, Jeffrey R., MS ; Yu, Sunkyung, MS ; Donohue, Janet, MPH ; Gajarski, Robert J., MD ; Charpie, John R., MD, PhD</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c595t-198ace1e837b91f94e5ff6052cec8d588ee9a1c1c95351452963306b1137f7923</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2014</creationdate><topic>Acidosis, Lactic - blood</topic><topic>Acidosis, Lactic - diagnosis</topic><topic>Acidosis, Lactic - etiology</topic><topic>Acidosis, Lactic - mortality</topic><topic>Age Factors</topic><topic>Area Under Curve</topic><topic>Biomarkers - blood</topic><topic>Cardiac Surgical Procedures - adverse effects</topic><topic>Cardiac Surgical Procedures - mortality</topic><topic>Cardiopulmonary Bypass</topic><topic>Cardiothoracic Surgery</topic><topic>Female</topic><topic>Heart Defects, Congenital - blood</topic><topic>Heart Defects, Congenital - diagnosis</topic><topic>Heart Defects, Congenital - mortality</topic><topic>Heart Defects, Congenital - surgery</topic><topic>Humans</topic><topic>Infant</topic><topic>Infant, Newborn</topic><topic>Intensive Care Units, Pediatric</topic><topic>Lactic Acid - blood</topic><topic>Male</topic><topic>Predictive Value of Tests</topic><topic>Prospective Studies</topic><topic>Risk Assessment</topic><topic>Risk Factors</topic><topic>ROC Curve</topic><topic>Time Factors</topic><topic>Treatment Outcome</topic><topic>Up-Regulation</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Schumacher, Kurt R., MS, MD</creatorcontrib><creatorcontrib>Reichel, Rebecca A., BS</creatorcontrib><creatorcontrib>Vlasic, Jeffrey R., MS</creatorcontrib><creatorcontrib>Yu, Sunkyung, MS</creatorcontrib><creatorcontrib>Donohue, Janet, MPH</creatorcontrib><creatorcontrib>Gajarski, Robert J., MD</creatorcontrib><creatorcontrib>Charpie, John R., MD, PhD</creatorcontrib><collection>ScienceDirect Open Access Titles</collection><collection>Elsevier:ScienceDirect:Open Access</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>The Journal of thoracic and cardiovascular surgery</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Schumacher, Kurt R., MS, MD</au><au>Reichel, Rebecca A., BS</au><au>Vlasic, Jeffrey R., MS</au><au>Yu, Sunkyung, MS</au><au>Donohue, Janet, MPH</au><au>Gajarski, Robert J., MD</au><au>Charpie, John R., MD, PhD</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Rate of increase in serum lactate level risk-stratifies infants after surgery for congenital heart disease</atitle><jtitle>The Journal of thoracic and cardiovascular surgery</jtitle><addtitle>J Thorac Cardiovasc Surg</addtitle><date>2014-08-01</date><risdate>2014</risdate><volume>148</volume><issue>2</issue><spage>589</spage><epage>595</epage><pages>589-595</pages><issn>0022-5223</issn><eissn>1097-685X</eissn><abstract>Objective Increased blood lactate levels reflect tissue oxygen debt and might be indicative of low cardiac output. We hypothesized that the rate of increase in serum lactate would be an ideal marker to discriminate between infants at high and low risk of a poor outcome after surgical repair of congenital heart disease using cardiopulmonary bypass. Methods In the present prospective, observational study in a pediatric cardiac intensive care unit, infants (aged <12 months) undergoing cardiac surgery had serial whole blood lactate levels measured with every arterial blood gas drawn for the first 24 postoperative hours. The composite poor outcome included death, the need for extracorporeal support, and dialysis. Results The lactate levels were measured in 231 infants; 19 infants (8.2%) had a poor outcome. A lactate increase rate of 0.6 mmol/L/h had very good discriminatory ability (area under the curve [AUC], 0.89) with a sensitivity of 90%, specificity of 84%, positive predictive value (PPV) of 34%, and negative predictive value (NPV) of 99%. Similar results were obtained for subgroups stratified by 1- or 2-ventricle heart disease and risk adjustment for congenital heart surgery (RACHS-1) score. In neonates (age <30 days) with single-ventricle physiology (n = 43, poor outcome = 8), a lactate increase of 0.6 mmol/L/h had near perfect discriminatory ability (AUC 0.99) with a sensitivity of 100%, specificity of 51%, PPV of 32%, and NPV of 100%. In 2-ventricle neonates (n = 43, poor outcome = 5), a lactate increase of 0.6 mmol/L/h also had near perfect discriminatory ability (AUC, 0.99), with a sensitivity of 100%, specificity of 90%, PPV of 56%, and NPV of 100%. Conclusions The postoperative lactate increase rate allows discrimination between infants at high and low risk of morbidity and mortality after congenital heart disease surgery, and the lactate level can be followed serially for the treatment response.</abstract><cop>United States</cop><pub>Mosby, Inc</pub><pmid>24138790</pmid><doi>10.1016/j.jtcvs.2013.09.002</doi><tpages>7</tpages><oa>free_for_read</oa></addata></record> |
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| subjects | Acidosis, Lactic - blood Acidosis, Lactic - diagnosis Acidosis, Lactic - etiology Acidosis, Lactic - mortality Age Factors Area Under Curve Biomarkers - blood Cardiac Surgical Procedures - adverse effects Cardiac Surgical Procedures - mortality Cardiopulmonary Bypass Cardiothoracic Surgery Female Heart Defects, Congenital - blood Heart Defects, Congenital - diagnosis Heart Defects, Congenital - mortality Heart Defects, Congenital - surgery Humans Infant Infant, Newborn Intensive Care Units, Pediatric Lactic Acid - blood Male Predictive Value of Tests Prospective Studies Risk Assessment Risk Factors ROC Curve Time Factors Treatment Outcome Up-Regulation |
| title | Rate of increase in serum lactate level risk-stratifies infants after surgery for congenital heart disease |
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