利用围手术期血清乳酸水平预测肝切除术后结局
Prediction of the Postoperative Outcome in Liver Resection Using Perioperative Serum Lactate Levels.
作者信息
Recknagel Sebastian, Rademacher Sebastian, Höhne Claudia, Lederer Andri A, Lange Undine G, Herta Toni, Seehofer Daniel, Sucher Robert, Scheuermann Uwe
机构信息
Department of Visceral, Transplantation, Vascular and Thoracic Surgery, University Hospital of Leipzig, 04103 Leipzig, Germany.
Department of Anesthesiology, Pain Therapy, Intensive Care and Emergency Medicine, DRK Hospital Berlin-Koepenick, 12559 Berlin, Germany.
出版信息
J Clin Med. 2023 Mar 7;12(6):2100. doi: 10.3390/jcm12062100.
BACKGROUND
The aim of our study was to analyze perioperative lactate levels and their predictive value for postoperative mortality and morbidity after liver resection.
METHODS
The clinicopathological characteristics and outcomes of 152 patients who underwent liver resection for benign and malign diagnoses were analyzed retrospectively. Lactate concentrations at three different time points, (1) before liver resection (LAC-PRE), (2) after liver resection on day 0 (LAC-POST), and (3) on day one after the operation (LAC-POD1) were assessed regarding the prognostic value in predicting postoperative complications and mortality according to the Clavien-Dindo (CD) classification.
RESULTS
The rates of postoperative complications (CD ≥ IIIb) and mortality rates were 19.7% (N = 30) and 4.6% (N = 7), respectively. The LAC-PRE levels showed no correlation with the postoperative outcome. The ROC curve analysis showed that LCT-POST and LCT-POD1 values were moderately strong in predicting postoperative morbidity (0.681 and 0.768, respectively) and had strong predictive accuracies regarding postoperative mortality (0.800 and 0.838, respectively). The multivariate analysis revealed LAC-POST as a significant predictor of postoperative complications (CD ≥ IIIb: OR 9.28; 95% CI: 2.88-29.9; < 0.001) and mortality (OR 11.69; 95% CI: 1.76-77.7; = 0.011).
CONCLUSION
Early postoperative lactate levels are a useful and easily practicable predictor of postoperative morbidity and mortality in patients after liver resection.
背景
我们研究的目的是分析围手术期乳酸水平及其对肝切除术后死亡率和发病率的预测价值。
方法
回顾性分析152例因良性和恶性诊断接受肝切除术患者的临床病理特征及预后。根据Clavien-Dindo（CD）分类，评估三个不同时间点的乳酸浓度，即（1）肝切除术前（LAC-PRE）、（2）肝切除术后第0天（LAC-POST）和（3）术后第1天（LAC-POD1）在预测术后并发症和死亡率方面的预后价值。
结果
术后并发症（CD≥IIIb）发生率和死亡率分别为19.7%（N = 30）和4.6%（N = 7）。LAC-PRE水平与术后结局无相关性。ROC曲线分析表明，LCT-POST和LCT-POD1值在预测术后发病率方面具有中等强度（分别为0.681和0.768），在预测术后死亡率方面具有较强的预测准确性（分别为0.800和0.838）。多因素分析显示，LAC-POST是术后并发症（CD≥IIIb：OR 9.28；95%CI：2.88 - 29.9；P < 0.001）和死亡率（OR 11.69；95%CI：1.76 - 77.7；P = 0.011）的重要预测指标。
结论
肝切除术后早期乳酸水平是预测患者术后发病率和死亡率的有用且易于实施的指标。
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