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Preoperative arterial lactate and outcome after surgery for type A aortic dissection: The ERTAAD multicenter study

医学 主动脉夹层 内科学 心脏病学 心脏外科 外科 主动脉
作者
Fausto Biancari,Francesco Nappi,Giuseppe Gatti,Andréa Perrotti,Amélie Hervé,Stefano Rosato,Paola D’Errigo,Matteo Pettinari,Sven Peterß,Joscha Buech,Tatu Juvonen,Mikko Jormalainen,Caius Mustonen,Lenard Conradi,Lenard Conradi,Marek Pol,Petr Kačer,Angelo M. Dell’Aquila,Konrad Wisniewski,Igor Vendramin,Daniela Piani,Luisa Ferrante,Timo H. Mäkikallio,Eduard Quintana,Robert Pruna‐Guillen,Antonio Fiore,Thierry Folliguet,Giovanni Mariscalco,Metesh Acharya,Mark Field,Manoj Kuduvalli,Francesco Onorati,Cecilia Rossetti,Sébastien Gerelli,Dario Di Perna,Enzo Mazzaro,Ángel Pinto,Javier Rodríguez Lega,Carlo De Vincentiis
出处
期刊:Heliyon [Elsevier BV]
卷期号:9 (10): e20702-e20702 被引量:1
标识
DOI:10.1016/j.heliyon.2023.e20702
摘要

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.The ERTAAD registry included consecutive patients who underwent surgery for acute type A aortic dissection (TAAD) at 18 European centers of cardiac surgery.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 %).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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