Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA.
Department of Cardiac Surgery, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA.
Cardiol Young. 2021 Sep;31(9):1401-1406. doi: 10.1017/S1047951121000263. Epub 2021 Feb 9.
To evaluate the discriminative ability of hyperlactataemia for early morbidity and mortality in neonates with CHD following cardiac surgery.
Retrospective, observational study of neonates who underwent cardiac surgery on cardiopulmonary bypass at a tertiary care children's hospital from June 2015 to June 2019. The primary predictor was lactate. The primary composite outcome was defined as ≥1 of the following: cardiac arrest or extracorporeal membrane oxygenation within 72 hours or 30-day mortality post-operatively. The secondary outcome was the presence of major residual lesions, according to the Technical Performance Score.
Of 432 neonates, 28 (6.5%) sustained the composite outcome. On univariate analysis, peak lactate within 48 hours, increase in lactate from ICU admission through 12 hours, and single ventricle physiology were significantly associated with the composite outcome. The peak lactate occurred at a median of 2.9 hours (interquartile range: 1, 35) before the event. Through multi-variable analysis, a multi-variable risk algorithm was created. Predicted probabilities demonstrated an increasing risk based on single ventricle status and delta lactate, ranging from 1.8% (95% CI: 0.9, 3.9) to 52.4% (95% CI: 32.4, 71.7). The model had good discriminative ability for the composite outcome on receiver operating characteristic analysis (area under the curve = 0.79; 95% CI: 0.75, 0.89). Moreover, a peak lactate of 7.3 mmol/l or greater was significantly associated with the presence of a major residual lesion (odds ratios: 5.16, 95% CI: 3.01, 8.87).
We present a simple, two-variable model, including delta lactate in the immediate post-operative period and single ventricle status, to prognosticate the risk of early morbidity and mortality in neonates undergoing cardiac surgery for potential intervention.
评估心脏手术后患有先天性心脏病（CHD）的新生儿高乳酸血症对早期发病率和死亡率的鉴别能力。
这是一项回顾性观察研究，纳入了 2015 年 6 月至 2019 年 6 月在一家三级儿童保健医院接受体外循环心脏手术的新生儿。主要预测因子为乳酸。主要复合结局定义为以下 1 项或多项：术后 72 小时内发生心脏骤停或体外膜肺氧合，或术后 30 天死亡。次要结局为根据技术性能评分存在主要残余病变。
在 432 名新生儿中，有 28 名（6.5%）发生了复合结局。在单变量分析中，48 小时内的峰值乳酸、从 ICU 入院到 12 小时乳酸的增加以及单心室生理与复合结局显著相关。事件发生前的中位峰值乳酸时间为 2.9 小时（四分位距：1，35）。通过多变量分析，创建了一个多变量风险算法。基于单心室状态和乳酸差值的预测概率显示出风险逐渐增加，范围从 1.8%（95%CI：0.9，3.9）到 52.4%（95%CI：32.4，71.7）。该模型在接受者操作特征分析中对复合结局具有良好的鉴别能力（曲线下面积=0.79；95%CI：0.75，0.89）。此外，峰值乳酸达到或超过 7.3mmol/L 与存在主要残余病变显著相关（比值比：5.16，95%CI：3.01，8.87）。
我们提出了一个简单的两变量模型，包括术后即刻的乳酸差值和单心室状态，以预测接受心脏手术的新生儿早期发病率和死亡率的风险，以便进行潜在干预。
