Department of Surgery, Seoul National University College of Medicine, Seoul, Korea.
Department of Critical Care Medicine , Seoul National University Hospital, Seoul, Korea.
BMC Surg. 2022 Mar 9;22(1):93. doi: 10.1186/s12893-022-01479-1.
This study aimed to compare the prognostic significance of pre and postoperative lactate levels and postoperative lactate clearance in the prediction of in-hospital mortality after surgery for gastrointestinal (GI) perforation.
Among patients who underwent surgery for GI perforation between 2013 and 2017, only patients whose lactate were measured before and after surgery were included and divided into an in-hospital mortality group and a survival group. Data on demographics, comorbidities, pre and postoperative laboratory test results, and operative findings were collected. Risk factors for in-hospital mortality were identified, and receiver-operating characteristic (ROC) curve analysis was performed for pre and postoperative lactate levels and postoperative lactate clearance.
Of 104 included patients, 17 patients (16.3%) died before discharge. The in-hospital mortality group demonstrated higher preoperative lactate (6.3 ± 5.1 vs. 3.5 ± 3.2, P = 0.013), SOFA score (4.5 ± 1.7 vs. 3.4 ± 2.3, P = 0.004), proportions of patients with lymphoma (23.5% vs. 2.3%, P = 0.006), and rates of contaminated ascites (94.1% vs. 68.2%, P = 0.036) and lower preoperative hemoglobin (10.4 ± 1.6 vs. 11.8 ± 2.4, P = 0.018) compare to the survival group. Multivariate analysis revealed that postoperative lactate (HR 1.259, 95% CI 1.084-1.463, P = 0.003) and preoperative hemoglobin (HR 0.707, 95% CI 0.520-0.959, P = 0.026) affected in-hospital mortality. In the ROC curve analysis, the largest area under the curve (AUC) was shown in the postoperative lactate level (AUC = 0.771, 95% CI 0.678-0.848).
Of perioperative lactate levels in patients underwent surgery for GI perforation, postoperative lactate was the strongest predictor for in-hospital mortality.
本研究旨在比较胃肠道（GI）穿孔手术后术前和术后乳酸水平及术后乳酸清除率对住院死亡率的预测价值。
纳入 2013 年至 2017 年间行手术治疗的 GI 穿孔患者，仅纳入术前和术后测量乳酸的患者，并分为住院死亡率组和生存组。收集患者的人口统计学、合并症、术前和术后实验室检查结果以及手术发现等数据。确定住院死亡率的危险因素，并对术前和术后乳酸水平及术后乳酸清除率进行受试者工作特征（ROC）曲线分析。
104 例患者中，17 例（16.3%）在出院前死亡。住院死亡率组术前乳酸水平（6.3±5.1 比 3.5±3.2，P=0.013）、SOFA 评分（4.5±1.7 比 3.4±2.3，P=0.004）、淋巴瘤患者比例（23.5%比 2.3%，P=0.006）和污染性腹水发生率（94.1%比 68.2%，P=0.036）较高，而术前血红蛋白水平（10.4±1.6 比 11.8±2.4，P=0.018）较低。多因素分析显示，术后乳酸（HR 1.259，95%CI 1.084-1.463，P=0.003）和术前血红蛋白（HR 0.707，95%CI 0.520-0.959，P=0.026）影响住院死亡率。在 ROC 曲线分析中，术后乳酸水平的曲线下面积（AUC）最大（AUC=0.771，95%CI 0.678-0.848）。
在胃肠道穿孔手术患者的围手术期乳酸水平中，术后乳酸是住院死亡率的最强预测因子。
