Department of Visceral, Transplant and Thoracic Surgery, Medical University of Innsbruck, Innsbruck, Austria.
J Hepatobiliary Pancreat Sci. 2020 Jul;27(7):359-370. doi: 10.1002/jhbp.727. Epub 2020 Mar 11.
Lactate measurements have proven utility as a triage tool, therapeutic guide, and prognostic indicator, with broad use in Acute Care and transplantation. Its value in guiding therapy and predicting outcomes following liver resection is less well-defined. This systematic review in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines assessed the relationship between peri-operative lactate levels and morbidity and mortality after liver resection. Seven relevant studies comprising 2573 patients in total were identified. Six studies assessed intra-operative or early postoperative lactate levels, one publication examined pre-operative levels. All studies demonstrated a significant association between peri-operative lactate levels and adverse outcomes. The influence of pre-operative diabetes and cirrhosis on postoperative lactate levels was shown in one study each, no study assessed the association of lactate with post-hepatectomy liver failure according to defined criteria. The heterogeneity of study measurements and end-points precluded a meta-analysis from being performed. Early postoperative lactate >3-3.7 mmol/L is associated with mortality but validation of clear cut-off levels for outcome prediction is pending. Literature suggests lactate is a useful predictive marker for outcomes post liver surgery, especially when measured in the early postoperative phase. Further research is required to standardize the use of lactate measurements in a meaningful therapeutic manner.
乳酸测量已被证明可作为分诊工具、治疗指导和预后指标，在急症护理和移植中广泛应用。它在指导肝切除术后治疗和预测结果方面的价值尚未得到明确界定。本系统评价按照系统评价和荟萃分析报告的首选项目进行，评估了围手术期乳酸水平与肝切除术后发病率和死亡率之间的关系。总共确定了 7 项相关研究，共涉及 2573 名患者。6 项研究评估了术中或术后早期的乳酸水平，1 项出版物研究了术前水平。所有研究均表明围手术期乳酸水平与不良结局之间存在显著关联。一项研究表明术前糖尿病和肝硬化对术后乳酸水平有影响，没有研究根据明确的标准评估乳酸与肝切除术后肝功能衰竭的关系。由于研究测量和终点的异质性，无法进行荟萃分析。术后早期乳酸水平>3-3.7mmol/L 与死亡率相关，但预测结果的明确截断值仍有待验证。文献表明，乳酸是肝手术后结局的有用预测标志物，尤其是在术后早期测量时。需要进一步研究以标准化乳酸测量在有意义的治疗方式中的应用。
