An Ran, Wu Xie, Bie Dongyun, Ding Jie, Li Yinan, Jia Yuan, Yuan Su, Yan Fuxia
Department of Anesthesiology, Fuwai Hospital, National Center of Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
CNS Neurosci Ther. 2025 Apr;31(4):e70380. doi: 10.1111/cns.70380.
The study aimed to determine the correlation between the maximum lactate on the first postoperative day and the incidence of postoperative delirium (POD) in patients after cardiac surgery.
The data of cardiac surgery patients were extracted from the Medical Information Mart for Intensive Care IV database. The cut-off value for the first postoperative day maximum lactate was determined, and all patients were categorized into two groups according to the cut-off value. Propensity score matching (PSM) was applied between the two groups, and the difference in the incidence of POD was analyzed. Then, we employed univariate logistic regression, multivariate logistic regression, PSM, and inverse probability of treatment weighting (IPTW) models to examine the relationship between the first postoperative day lactate levels and POD.
Among the 4856 patients enrolled, there was a significant difference in lactate-max on the first postoperative day between patients without POD and patients with POD (median 2.5 vs. 3.1, p < 0.001). The cut-off value of lactate-max was 2.85 mmol/L. For the two groups after PSM, the incidence of POD in the lactate-max ≥ 2.85 mmol/L group was significantly elevated (19.2% vs. 15.9%, p = 0.029). The elevated lactate-max on the first postoperative day was substantially associated with an increased risk of POD in univariate and multivariate logistic regression analyses, PSM, and IPTW models.
The results demonstrated that the first postoperative day lactate-max was correlated with the risk of POD in patients undergoing cardiac surgery, with the POD risk increasing significantly in patients with a lactate-max ≥ 2.85 mmol/L on the first postoperative day.
本研究旨在确定心脏手术后患者术后第一天的最大乳酸水平与术后谵妄（POD）发生率之间的相关性。
从重症监护医学信息数据库IV中提取心脏手术患者的数据。确定术后第一天最大乳酸水平的临界值，并根据该临界值将所有患者分为两组。对两组进行倾向得分匹配（PSM），分析POD发生率的差异。然后，我们采用单因素逻辑回归、多因素逻辑回归、PSM和治疗逆概率加权（IPTW）模型来研究术后第一天乳酸水平与POD之间的关系。
在纳入的4856例患者中，无POD患者与有POD患者术后第一天的最大乳酸水平存在显著差异（中位数2.5 vs. 3.1，p < 0.001）。最大乳酸水平的临界值为2.85 mmol/L。PSM后的两组中，最大乳酸水平≥2.85 mmol/L组的POD发生率显著升高（19.2% vs. 15.9%，p = 0.029）。在单因素和多因素逻辑回归分析、PSM和IPTW模型中，术后第一天升高的最大乳酸水平与POD风险增加显著相关。
结果表明，心脏手术患者术后第一天的最大乳酸水平与POD风险相关，术后第一天最大乳酸水平≥2.85 mmol/L的患者POD风险显著增加。
