Wang Zhigang, Xu Jingfang, Kang Yubei, Liu Ling, Zhang Lifang, Wang Dongjin
Department of Cardio-Thoracic Surgery, Affiliated Drum Tower Hospital, Medical School of Nanjing University, Nanjing, China.
Department of Nephrology, Nanjing Drum Tower Hospital Clinical College of Nanjing University of Chinese Medicine, Nanjing, China.
Front Cardiovasc Med. 2022 Jul 26;9:948672. doi: 10.3389/fcvm.2022.948672. eCollection 2022.
It has been well known that hyperlactatemia is an independent risk factor for postoperative mortality in patients who received acute type A aortic dissection (ATAAD) surgery. Some patients may require the assistance of continuous renal replacement therapy (CRRT) for acute postoperative renal deficiency and often associate with increased mortality rate. This study aimed to examine the association between the early dynamic change of lactate levels and postoperative CRRT in ATAAD patients who received surgical repairment.
This retrospective study included 503 patients who received ATAAD surgeries. Serum lactate levels were measured before operation and at 0, 1, 3, 6, 12, 24 h post intensive care unit (ICU) admission. We examined the association between dynamic changes of lactate and CRRT.
Among all patients, 19.9% (100 patients) required CRRT. Our data showed that the lactate levels were higher in the CRRT group at all timepoints compared to the non-CRRT group. In a multivariate model, lactate levels at 12 h post ICU admission [odds ratio (OR), 1.362; = 0.007] was identified as an independent predictor for requiring CRRT. Unsurprisingly, 30-day mortality in the CRRT group (41%) was 8.2 times higher than in the non-CRRT group (5%). To better understand the associations between CRRT and lactate levels, patients in the CRRT group were further stratified into the non-survivor group ( = 41) and survivor group ( = 59) based on the 30-day mortality. Elevated lactate levels measured upon ICU admission (OR, 1.284; = 0.001) and decreased 24 h lactate clearance (OR, 0.237; = 0.039) were independent risk factors for 30-day mortality in patients who received CRRT. The area under the curve to predict requirement for CRRT at 6 and 12 h post CICU admission were 0.714 and 0.722, respectively, corresponding to lactate cut-off levels of 4.15 and 2.45 mmol/L.
The CRRT is commonly required in patients who received ATAAD surgery and often associated with worse mortality. Early dynamic changes of lactate levels can be used to predict the requirement of postoperative CRRT.
众所周知，高乳酸血症是接受急性A型主动脉夹层（ATAAD）手术患者术后死亡的独立危险因素。一些患者可能需要连续性肾脏替代治疗（CRRT）来辅助治疗术后急性肾功能不全，且这常与死亡率增加相关。本研究旨在探讨接受手术修复的ATAAD患者乳酸水平的早期动态变化与术后CRRT之间的关联。
这项回顾性研究纳入了503例接受ATAAD手术的患者。在手术前以及重症监护病房（ICU）入院后0、1、3、6、12、24小时测量血清乳酸水平。我们研究了乳酸的动态变化与CRRT之间的关联。
在所有患者中，19.9%（100例）需要CRRT。我们的数据显示，与非CRRT组相比，CRRT组在所有时间点的乳酸水平均更高。在多变量模型中，ICU入院后12小时的乳酸水平[比值比（OR），1.362；P = 0.007]被确定为需要CRRT的独立预测因素。不出所料，CRRT组的30天死亡率（41%）比非CRRT组（5%）高8.2倍。为了更好地理解CRRT与乳酸水平之间的关联，根据30天死亡率将CRRT组患者进一步分为非存活组（n = 41）和存活组（n = 59）。ICU入院时测得的乳酸水平升高（OR，1.284；P = 0.001）和24小时乳酸清除率降低（OR，0.237；P = 0.039）是接受CRRT患者30天死亡率的独立危险因素。预测CICU入院后6小时和12小时需要CRRT的曲线下面积分别为0.714和0.722，对应的乳酸截断水平分别为4.15和2.45 mmol/L。
接受ATAAD手术的患者通常需要CRRT，且这常与更差的死亡率相关。乳酸水平的早期动态变化可用于预测术后CRRT需求。
