The Association of Perioperative Serum Lactate Levels with Postoperative Delirium in Elderly Trauma Patients.

Cheol Lee,Hyunho Cho,Juhwan Lee,Jihyo Hwang,Jaekyeong Song,Xiao Ma,Hojung Jung

doi:10.1155/2019/3963780

Cheol Lee, Hyunho Cho + Show 5 more

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https://doi.org/10.1155/2019/3963780

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Abstract

Background Several studies have shown the utility of lactate level as a predictor of early outcomes in trauma patients. We conducted this study to evaluate the association of perioperative serum lactate levels with postoperative delirium (POD) in elderly trauma patients. Materials and Methods This study included 466 elderly trauma patients with measurements of serum lactate levels on admission and 1 h after surgery. The associations of POD with serum lactate levels (on admission and 1 h after surgery) and lactate clearance were analyzed using Kendall's correlation. Perioperative serum lactate levels and lactate clearance as predictors of POD were evaluated using univariate and multivariable analyses. Results The incidence of POD in the present study was 38.1%. Serum lactate levels on admission and at 1 h after surgery were significantly higher in major trauma than in minor trauma. In univariate analysis of perioperative serum lactate levels and lactate clearance as predictors of POD, the odds ratio (OR) for serum lactate level on admission was 4.19 (P < 0.01, 2.91 < 95% confidence interval (CI) < 6.02) and that 1 h after surgery was 3.83 (P < 0.01, 2.79 < 95% CI < 5.25); however, the OR for serum change of lactate level was 0.99 ((P < 0.09, 0.99 < 95% CI < 1.00). In multivariable analysis for predictors of POD, the OR for serum lactate level on admission was 2.40 (P < 0.09, 0.87 < 95% CI < 6.7), that for serum lactate 1 h after surgery was 2.83 (P=0.01, 1.28 < 95% CI < 6.24), that for ICU admission was 3.01 (P=0.01, 2.09 < 95% CI < 6.03), and that for ISS was 1.47 (P < 0.01, 1.27 < 95% CI < 3.70). Conclusions Taking together the results of univariate and multivariable analyses, serum lactate level 1 h after surgery may be used as a prediction model of POD development in elderly trauma patients.

Highlights

Postoperative delirium (POD) is the most common neurologic complication of major surgery in patients older than 65 years. e development of delirium reflects both the severity of illness and advancing age of the patient [2, 3]. e incidence of POD after major surgery varies between 10% and 70% depending on the criteria used for diagnosis, the population studied, and the type of surgical procedure [4,5,6]
In this retrospective cohort study, we evaluated the medical records of all consecutive geriatric trauma patients admitted from January 1, 2009, through June 30, 2018, to a level 1 single trauma center that provides the highest level of care and comprehensive service for trauma patients
Patients >65 years of age who were with trauma and potential mild traumatic brain injury, classified as class I to IV according to the American Society of Anesthesiologists (ASA) classification, and scheduled for surgery under general anesthesia were considered eligible for inclusion in this study

Summary

Introduction

Elevated lactate levels are observed in severely hypotensive trauma patients and may be seen in normotensive patients with multiple injuries. us, serum lactate level can be used as a marker of the balance between oxygen demand and availability, and changes in serum lactate levels have been shown to be an effective prognostic biomarker of mortality in critically ill trauma patients, including those with stable vital signs [1].Postoperative delirium (POD) is the most common neurologic complication of major surgery in patients older than 65 years. e development of delirium reflects both the severity of illness and advancing age of the patient [2, 3]. e incidence of POD after major surgery varies between 10% and 70% depending on the criteria used for diagnosis, the population studied, and the type of surgical procedure [4,5,6].e underlying pathophysiology of POD is not well understood. e suggested mechanisms include neuronal aging, oxidative stress, neuroinflammation, neurotransmitter deficiency, diurnal dysregulation, neuroendocrine activation, and brain network connectivity change [7].In trauma medicine, both patients with established delirium, wherein the delirium has preceded or sometimes led to trauma, and those with incident delirium, which develops as a consequence of trauma and hospitalizationBioMed Research International process, are encountered [8, 9]. Erefore, the elevated serum lactate levels in elderly trauma patients might be associated with the incidence of POD. E aim of our study was to assess the effect of serum lactate level on the development of POD in elderly trauma patients, as a primary outcome.

Results

Conclusion