体外循环心脏手术后术中乳酸水平与急性肾损伤的关联：一项跨两个中心的回顾性队列研究
Association between intraoperative lactate levels and acute kidney injury after on-pump cardiac surgery: a retrospective cohort study across two centers.
作者信息
Chen Dong Xu, Zhang Yu Yang, Xiong Xing Long, Zhou Leng, Shi Jing
机构信息
Department of Anesthesiology, West China Second University Hospital, Sichuan University, No. 20, Section 3, South Renmin Road, Chengdu, 610041, China.
Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, Chengdu, 610041, China.
出版信息
BMC Surg. 2025 Jul 30;25(1):324. doi: 10.1186/s12893-025-03082-6.
BACKGROUND
Hyperlactatemia and acute kidney injury (AKI) represent significant perioperative complications in cardiac surgery. This study investigated their relationship by analyzing multiple lactate parameters during on-pump cardiac procedures.
METHODS
In this dual-center retrospective analysis of 5255 cardiac surgery patients, we evaluated the relationship between AKI and four distinct lactate parameters: baseline, mean, peak, and time-weighted average (TWA) concentrations. The association between lactate levels and outcomes was evaluated using restricted cubic spline functions with five knots in our retrospective statistical modeling approach. Concurrently, optimal lactate thresholds were determined through the application of a classification and regression tree algorithm.
RESULTS
Among the 5255 patients analyzed, 931 (17.72%) developed acute kidney injury. Statistical analysis revealed distinct patterns of association between lactate parameters and AKI risk. We identified an L-shaped relationship for mean, peak, and TWA lactate levels, contrasting with a linear association for baseline values. The study established critical thresholds for AKI risk prediction: mean lactate (2.96 mmol/L), peak lactate (4.50 mmol/L), and TWA lactate (2.33 mmol/L). Risk stratification demonstrated that patients in higher lactate quintiles faced substantially increased AKI risk, with odds ratios ranging from 1.34 to 4.37 across different lactate parameters.
CONCLUSION
These findings established specific lactate thresholds as valuable predictive markers for AKI risk in cardiac surgery, offering clinically applicable parameters for perioperative risk assessment and management. This data supported the implementation of targeted lactate monitoring strategies during cardiac procedures.
TRIAL REGISTRATION
The study was registered at www.chictr.org.cn (Registration number: ChiCTR2200057320, Data of Registration: 2022-03-08).
背景
高乳酸血症和急性肾损伤（AKI）是心脏手术中重要的围手术期并发症。本研究通过分析体外循环心脏手术过程中的多个乳酸参数来探讨它们之间的关系。
方法
在这项对5255例心脏手术患者的双中心回顾性分析中，我们评估了AKI与四个不同乳酸参数之间的关系：基线、平均、峰值和时间加权平均（TWA）浓度。在我们的回顾性统计建模方法中，使用带有五个节点的受限立方样条函数评估乳酸水平与结局之间的关联。同时，通过应用分类回归树算法确定最佳乳酸阈值。
结果
在分析的5255例患者中，931例（17.72%）发生了急性肾损伤。统计分析揭示了乳酸参数与AKI风险之间不同的关联模式。我们发现平均、峰值和TWA乳酸水平呈L形关系，而基线值呈线性关联。该研究确定了AKI风险预测的临界阈值：平均乳酸（2.96 mmol/L）、峰值乳酸（4.50 mmol/L）和TWA乳酸（2.33 mmol/L）。风险分层表明，处于较高乳酸五分位数的患者面临的AKI风险显著增加，不同乳酸参数的优势比在1.34至4.37之间。
结论
这些发现确定了特定的乳酸阈值作为心脏手术中AKI风险的有价值预测标志物，为围手术期风险评估和管理提供了临床适用参数。该数据支持在心脏手术过程中实施有针对性的乳酸监测策略。
试验注册
该研究在www.chictr.org.cn注册（注册号：ChiCTR2200057320，注册日期：2022年3月8日）。
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