Les variations peropératoires du lactate sanguin sont associées à un pronostic défavorable à court terme après chirurgie cardiaque sous circulation extracorporelle

Abstract : Background: A high perioperative blood lactate level has been reported to be associated with poor outcomes after cardiac surgery. More than isolated lactates value peaks it would be more interesting to consider intraoperative changes in blood lactate level (∆Lact). Our large-scale retrospective study evaluated the relationship between ∆Lact and overall Intensive Care Unit (ICU) morbidity and all-cause 30-day mortality. Methods: Perioperative data from consecutive patients undergoing on-pump cardiac surgery from September 2010 to June 2016 were retrospectively analysed. The first lactate level was measured immediately after induction of anaesthesia and then periodically throughout the surgery. The intraoperative ∆Lact was defined as the difference between the highest intraoperative blood lactate and the baseline lactate level. Patients were further stratified into 4 groups according to the ∆Lact: ≤ 0, 0.1–0.9, 1–1.9 and ≥ 2 mmol.L-1. Results: Among 7795 patients eligible during the study period, 7447 patients were analysed. The median ∆Lact of our patients was 0.6 [0.3–1] mmol.L-1. Most of studied patients (65.9%) exhibited an ∆Lact between 0.1 and 0.9 mmol.L-1. Our analysis detected a concentration-dependent relationship could be observed between ∆Lact and ICU morbidity and 30-day mortality rate. After adjustment for co-variables, all ∆Lact > 0 mmol.L-1 were associated with an increased overall ICU morbidity. An independent relationship was also found between ∆Lact and 30-day mortality in patients with an increase of 1 mmol.L-1. Conclusions: Intraoperative ∆Lact considering preoperative value is associated with poor short-term outcomes in adult cardiac surgical patients.
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Master Thesis
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Benoît Duval. Les variations peropératoires du lactate sanguin sont associées à un pronostic défavorable à court terme après chirurgie cardiaque sous circulation extracorporelle. Chirurgie. 2018. ⟨dumas-02002582⟩

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