Is Serum D-lactate a New Biomarker of Postoperative Complications after Liver Resection?

Abstract

Introduction: L-lactate is considered a prognostic factor for postoperative complications. However, the role of D-lactate produced by intestinal bacteria is not known in patients undergoing liver resection. The aims of the study were to assess factors related to the increase of serum lactates values and investigate the association between lactate isoforms and postoperative complications. Methods: From February 2018 through October 2018, perioperative data of 68 consecutive patients underwent hepatic resection at the Division of Hepatobiliary Surgery, Verona University Hospital were prospectively collected. Serum levels of both L- and D-lactate were evaluated by arterial sampling before (T0) and after (T1) general anesthesia induction, before (T2) and after (T3) Pringle maneuver, during laparotomy suture (T4), 2-(T5) and 4-(T6) hours after surgery, in postoperative day 1(T7), 2(T8), 3(T9) and at discharge (T10). Results: Complication Clavien-Dindo grade ≥ 3 and mortality were 20.6 and 1.5%, respectively. Factors related to the increase of perioperative serum lactates were major liver resection (T7, L-lactate p=0.001 and D-lactate p=0.018), hilar clamping (D-lactate, T3 p=0.004; T4, p=0.013), operative time > 300 minutes (L-lactate, T7 p=0.005; T9 p=0.034), and mean arterial pressure < 80 mmHg (L-lactate, T3 p=0.031; T4 p=0.021). Higher L-lactate values were associated to overall postoperative complications (T4, p=0.049; T9, p=0.002). Instead, higher D-lactate values resulted specifically associated only to postoperative infections (T7, p=0.007). Conclusion: In this preliminary study we observed that surgery-related factors increase both isoforms of serum lactate. L-lactate raise if postoperative complications whereas higher D-lactate values may be used as biomarker of postoperative infections.