Abstract
Objectives: Postoperative hyperlactatemia (POHL) is common in patients undergoing cardiac surgery and is associated with poor outcomes. The purpose of this study was to develop and validate two predictive models for POHL in patients undergoing elective cardiac surgery (ECS).Methods: We conducted a multicenter retrospective study enrolling 13,454 adult patients who underwent ECS. All patients involved in the analysis were randomly assigned to a training set and a validation set. Univariate and multivariate analyses were performed to identify risk factors for POHL in the training cohort. Based on these independent predictors, the nomograms were constructed to predict the probability of POHL and were validated in the validation cohort.Results: A total of 1,430 patients (10.6%) developed POHL after ECS. Age, preoperative left ventricular ejection fraction, renal insufficiency, cardiac surgery history, intraoperative red blood cell transfusion, and cardiopulmonary bypass time were independent predictors and were used to construct a full nomogram. The second nomogram was constructed comprising only the preoperative factors. Both models showed good predictive ability, calibration, and clinical utility. According to the predicted probabilities, four risk groups were defined as very low risk (<0.05), low risk (0.05–0.1), medium risk (0.1–0.3), and high risk groups (>0.3), corresponding to scores of ≤ 180 points, 181–202 points, 203–239 points, and >239 points on the full nomogram, respectively.Conclusions: We developed and validated two nomogram models to predict POHL in patients undergoing ECS. The nomograms may have clinical utility in risk estimation, risk stratification, and targeted interventions.
Highlights
Postoperative hyperlactatemia (POHL) is a common metabolic disorder in patients undergoing cardiac surgery and is associated with adverse clinical outcomes, such as severe acute kidney injury, acute respiratory distress syndrome, and mortality [1,2,3]
The majority of the published studies were conducted in patients undergoing mixed surgeries or single valvular heart surgery [13, 14], but none were conducted for patients undergoing elective cardiac surgery (ECS)
We found that POHL was an independent predictor for both of the two outcomes, and patients with POHL had a 2.13-fold increased risk of readmission to intensive care unit (ICU) (p < 0.001) and a 2.34-fold increased risk of mortality (p < 0.001)
Summary
Postoperative hyperlactatemia (POHL) is a common metabolic disorder in patients undergoing cardiac surgery and is associated with adverse clinical outcomes, such as severe acute kidney injury, acute respiratory distress syndrome, and mortality [1,2,3]. Studies on lactate-directed therapy performed in post-cardiac surgery patients are limited [5]. The reported incidence of POHL in different studies varied greatly, from 11.1 to 45.6% [6, 7]. Numerous studies have been conducted to explore predictors for POHL after cardiac surgery due to its high prevalence and poor outcomes [8,9,10]. Many studies were published decades ago, and some conclusions may have been obsolete because of the very limited samples and narrow patient selection [3, 12]. The majority of the published studies were conducted in patients undergoing mixed surgeries or single valvular heart surgery [13, 14], but none were conducted for patients undergoing elective cardiac surgery (ECS). A large-scale persuasive study on this topic is still lacking, and the establishment of a convincing prediction model is still an urgent need
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