Preoperative arterial lactate and outcome after surgery for type A aortic dissection: The ERTAAD multicenter study
Biancari, Fausto; Nappi, Francesco; Gatti, Giuseppe; Perrotti, Andrea; Hervé, Amélie; Rosato, Stefano; D'Errigo, Paola; Pettinari, Matteo; Peterss, Sven; Buech, Joscha; Juvonen, Tatu; Jormalainen, Mikko; Mustonen, Caius; Demal, Till; Conradi, Lenard; Pol, Marek; Kacer, Petr; Dell'Aquila, Angelo M.; Wisniewski, Konrad; Vendramin, Igor; Piani, Daniela; Ferrante, Luisa; Mäkikallio, Timo; Quintana, Eduard; Pruna-Guillen, Robert; Fiore, Antonio; Folliguet, Thierry; Mariscalco, Giovanni; Acharya, Metesh; Field, Mark; Kuduvalli, Manoj; Onorati, Francesco; Rossetti, Cecilia; Gerelli, Sebastien; Di Perna, Dario; Mazzaro, Enzo; Pinto, Angel G.; Lega, Javier Rodriguez; Rinaldi, Mauro (2023-10-05)
Elsevier
05.10.2023
Biancari, F., Nappi, F., Gatti, G., Perrotti, A., Hervé, A., Rosato, S., D’Errigo, P., Pettinari, M., Peterss, S., Buech, J., Juvonen, T., Jormalainen, M., Mustonen, C., Demal, T., Conradi, L., Pol, M., Kacer, P., Dell’Aquila, A. M., Wisniewski, K. et al. (2023). Preoperative arterial lactate and outcome after surgery for type A aortic dissection: The ERTAAD multicenter study. In Heliyon (Vol. 9, Issue 10, p. e20702). Elsevier BV. https://doi.org/10.1016/j.heliyon.2023.e20702.
https://creativecommons.org/licenses/by/4.0/
© 2023 The Authors. Published by Elsevier Ltd. This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/).
https://creativecommons.org/licenses/by/4.0/
© 2023 The Authors. Published by Elsevier Ltd. This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/).
https://creativecommons.org/licenses/by/4.0/
Julkaisun pysyvä osoite on
https://urn.fi/URN:NBN:fi:oulu-202312073549
https://urn.fi/URN:NBN:fi:oulu-202312073549
Tiivistelmä
Abstract
Background:
Acute type A aortic dissection (TAAD) is associated with significant mortality and morbidity. In this study we evaluated the prognostic significance of preoperative arterial lactate concentration on the outcome after surgery for TAAD.
Methods:
The ERTAAD registry included consecutive patients who underwent surgery for acute type A aortic dissection (TAAD) at 18 European centers of cardiac surgery.
Results:
Data on arterial lactate concentration immediately before surgery were available in 2798 (71.7 %) patients. Preoperative concentration of arterial lactate was an independent predictor of in-hospital mortality (mean, 3.5 ± 3.2 vs 2.1 ± 1.8 mmol/L, adjusted OR 1.181, 95%CI 1.129–1.235). The best cutoff value preoperative arterial lactate concentration was 1.8 mmol/L (in-hospital mortality, 12.0 %, vs. 26.6 %, p < 0.0001). The rates of in-hospital mortality increased along increasing quintiles of arterial lactate and it was 12.1 % in the lowest quintile and 33.6 % in the highest quintile (p < 0.0001). The difference between multivariable models with and without preoperative arterial lactate was statistically significant (p = 0.0002). The NRI was 0.296 (95%CI 0.200–0.391) (p < 0.0001) with −17 % of events correctly reclassified (p = 0.0002) and 46 % of non-events correctly reclassified (p < 0.0001). The IDI was 0.025 (95%CI 0.016–0.034) (p < 0.0001). Six studies from a systematic review plus the present one provided data for a pooled analysis which showed that the mean difference of preoperative arterial lactate between 30-day/in-hospital deaths and survivors was 1.85 mmol/L (95%CI 1.22–2.47, p < 0.0001, I2 64 %).
Conclusions:
Hyperlactatemia significantly increased the risk of mortality after surgery for acute TAAD and should be considered in the clinical assessment of these critically ill patients.
Background:
Acute type A aortic dissection (TAAD) is associated with significant mortality and morbidity. In this study we evaluated the prognostic significance of preoperative arterial lactate concentration on the outcome after surgery for TAAD.
Methods:
The ERTAAD registry included consecutive patients who underwent surgery for acute type A aortic dissection (TAAD) at 18 European centers of cardiac surgery.
Results:
Data on arterial lactate concentration immediately before surgery were available in 2798 (71.7 %) patients. Preoperative concentration of arterial lactate was an independent predictor of in-hospital mortality (mean, 3.5 ± 3.2 vs 2.1 ± 1.8 mmol/L, adjusted OR 1.181, 95%CI 1.129–1.235). The best cutoff value preoperative arterial lactate concentration was 1.8 mmol/L (in-hospital mortality, 12.0 %, vs. 26.6 %, p < 0.0001). The rates of in-hospital mortality increased along increasing quintiles of arterial lactate and it was 12.1 % in the lowest quintile and 33.6 % in the highest quintile (p < 0.0001). The difference between multivariable models with and without preoperative arterial lactate was statistically significant (p = 0.0002). The NRI was 0.296 (95%CI 0.200–0.391) (p < 0.0001) with −17 % of events correctly reclassified (p = 0.0002) and 46 % of non-events correctly reclassified (p < 0.0001). The IDI was 0.025 (95%CI 0.016–0.034) (p < 0.0001). Six studies from a systematic review plus the present one provided data for a pooled analysis which showed that the mean difference of preoperative arterial lactate between 30-day/in-hospital deaths and survivors was 1.85 mmol/L (95%CI 1.22–2.47, p < 0.0001, I2 64 %).
Conclusions:
Hyperlactatemia significantly increased the risk of mortality after surgery for acute TAAD and should be considered in the clinical assessment of these critically ill patients.
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