Kędziora Anna, Wierzbicki Karol, Piątek Jacek, Hymczak Hubert, Górkiewicz-Kot Izabela, Milaniak Irena, Tomsia Paulina, Sobczyk Dorota, Drwila Rafal, Kapelak Boguslaw
Department of Cardiovascular Surgery and Transplantology, John Paul II Hospital, Institute of Cardiology, Jagiellonian University Medical College, Krakow, Poland.
Department of Anesthesiology and Intensive Care, John Paul II Hospital, Krakow, Poland.
PeerJ. 2020 Feb 6;8:e8334. doi: 10.7717/peerj.8334. eCollection 2020.
Advanced heart failure (HF), that affects 10% of the HF population, is associated with high mortality rate, meeting 50% at 1-year from diagnosis. For these individuals, heart transplantation (HTX) remains the ultimate and the gold-standard treatment option. Serum lactate level measurements has been proven useful for determining the outcome following other cardiac surgeries and among critically ill patients. Increased serum lactate levels are expected following HTX; however, no detailed analysis has been yet performed in this population. The research aims to estimate the prevalence of hyperlactatemia and describe early postoperative serum lactate level trends among heart transplant recipients.
Forty-six consecutive patients, who underwent HTX between 2010 and 2015, were enrolled into the retrospective analysis. Serum lactate level measurements within first 48 hours post-HTX were obtained every 6 hours from routinely conducted arterial blood gas analyses. The threshold for hyperlactatemia was considered at >1.6 mmol/L, according to upper limit of normal, based on internal laboratory standardization. The highest observed measurement within the observation, regardless of the time point of observation was determined for each patient individually and was appointed as .
Consecutively measured serum lactate levels differed in time ( = 0.000), with the initial increase and subsequent decrease of the values (4.3 vs. 1.9 mmol/l; = 0.000). The increase from the baseline level to the was statistically significant (4.3 vs. 7.0 mmol/l; = 0.000). Various serum lactate level trends were identified, with one or more hyperlactatemia episodes. Eventually, 50% of the individuals had normal serum lactate levels at the end of the study, and hyperlactatemia was observed in the other half.
Throughout the observation, all of the patients experienced at least one episode of hyperlactatemia, with the median of 7.0 (4.5-8.4) mmol/L. Various serum lactate level trends can be identified in post-HTX patients. Further research is required to determine the clinical usefulness of newly reported serum lactate level trends among heart transplant recipients.
晚期心力衰竭（HF）影响10%的HF患者群体，与高死亡率相关，诊断后1年死亡率达50%。对于这些患者，心脏移植（HTX）仍然是最终的金标准治疗选择。血清乳酸水平测量已被证明有助于确定其他心脏手术后以及重症患者的预后。HTX后血清乳酸水平预计会升高；然而，尚未对该人群进行详细分析。本研究旨在评估心脏移植受者中高乳酸血症的患病率，并描述术后早期血清乳酸水平变化趋势。
对2010年至2015年间连续接受HTX的46例患者进行回顾性分析。通过常规动脉血气分析，每6小时获取HTX后48小时内的血清乳酸水平测量值。根据内部实验室标准化的正常上限，高乳酸血症的阈值设定为>1.6 mmol/L。为每位患者单独确定观察期内观察到的最高测量值，无论观察时间点如何，并将其指定为 。
连续测量的血清乳酸水平随时间变化（ = 0.000），数值先升高后降低（4.3对1.9 mmol/L； = 0.000）。从基线水平到 的升高具有统计学意义（4.3对7.0 mmol/L； = 0.000）。识别出各种血清乳酸水平变化趋势，伴有一次或多次高乳酸血症发作。最终，50%的患者在研究结束时血清乳酸水平正常，另一半患者出现高乳酸血症。
在整个观察期内，所有患者均经历至少一次高乳酸血症发作， 的中位数为7.0（4.5 - 8.4）mmol/L。HTX术后患者可识别出各种血清乳酸水平变化趋势。需要进一步研究以确定新报道的心脏移植受者血清乳酸水平变化趋势的临床实用性。
