Department of Nursing, Fujian Medical University Union Hospital.
Department of Nursing, Fujian Medical University.
Int Heart J. 2023;64(4):717-723. doi: 10.1536/ihj.22-290.
Several studies have found that lactate correlates with surgical outcomes in patients with heart disease. However, the prognostic value of postoperative lactate in patients with acute type A aortic dissection (AAAD) remains unclear. This study aimed to investigate the relationship between postoperative lactate and in-hospital mortality in patients with AAAD. Patients who underwent AAAD surgery at Fujian Cardiac Medical Center from February 2020 to January 2022 were enrolled in this retrospective study. Correlations between in-hospital mortality and various parameters, including lactate, were investigated. A total of 357 patients were included in this study, 58 of which died. Multivariate logistic regression analysis revealed that body mass index (BMI) (odds ratio [OR] = 1.099, 95% confidence interval [CI]: 1.017-1.188, P = 0.017), cardiopulmonary bypass (CPB) time (OR = 1.005; 95% CI: 1.000-1.010, P = 0.039), and lactate (OR = 1.291, 95% CI: 1.182-1.409, P < 0.001) were independent risk factors for in-hospital mortality in AAAD patients. Receiver operating characteristic (ROC) curve analysis showed that lactate had a moderate power for in-hospital mortality (area under the curve [AUC] = 0.729, 95% CI: 0.647-0.810, P < 0.001). Furthermore, the combination of lactate, BMI, and CPB time showed better performance (AUC = 0.780; 95% CI: 0.706-0.854, P < 0.001) in predicting in-hospital mortality than in using these variables independently. Among patients undergoing AAAD surgery, postoperative lactate was significantly associated with in-hospital mortality. Lactate can be used as a potential predictor of in-hospital mortality. The combination of lactate, BMI, and CPB time showed better performance in predicting in-hospital mortality than using single one.
几项研究发现，乳酸与心脏病患者的手术结果相关。然而，急性 A 型主动脉夹层 (AAAD) 患者术后乳酸的预后价值尚不清楚。本研究旨在探讨 AAAD 患者术后乳酸与院内死亡率的关系。本回顾性研究纳入了 2020 年 2 月至 2022 年 1 月在福建心脏医学中心接受 AAAD 手术的患者。研究了院内死亡率与包括乳酸在内的各种参数之间的相关性。共有 357 例患者纳入本研究，其中 58 例死亡。多变量逻辑回归分析显示，体重指数 (BMI) (比值比 [OR] = 1.099，95%置信区间 [CI]：1.017-1.188，P = 0.017)、体外循环 (CPB) 时间 (OR = 1.005；95% CI：1.000-1.010，P = 0.039) 和乳酸 (OR = 1.291，95% CI：1.182-1.409，P < 0.001) 是 AAAD 患者院内死亡的独立危险因素。受试者工作特征 (ROC) 曲线分析表明，乳酸对院内死亡率具有中等预测能力 (曲线下面积 [AUC] = 0.729，95% CI：0.647-0.810，P < 0.001)。此外，乳酸、BMI 和 CPB 时间的组合在预测院内死亡率方面表现优于单独使用这些变量 (AUC = 0.780；95% CI：0.706-0.854，P < 0.001)。在接受 AAAD 手术的患者中，术后乳酸与院内死亡率显著相关。乳酸可作为院内死亡率的潜在预测指标。乳酸、BMI 和 CPB 时间的组合在预测院内死亡率方面的表现优于单独使用。
