Clinical Physiology of Circulation

Chief Editor

Leo A. Bockeria, MD, PhD, DSc, Professor, Academician of Russian Academy of Sciences, President of Bakoulev National Medical Research Center for Cardiovascular Surgery


Hyperlactatemia and organ dysfunction in the early postoperative period in patients with heart valves defects

Authors: Yudin G.V., Goncharov A.A., Rybka M.M., Dibin D.A., Lomakin M.V., Khinchagov D.Ya.

Company:
Bakoulev National Medical Research Center for Cardiovascular Surgery, Moscow, 121552, Russian Federation

E-mail: Сведения доступны для зарегистрированных пользователей.

DOI: https://doi.org/10.24022/1814-6910-2020-17-4-319-328

UDC: 616.12-007.1-083.98

Link: Clinical Physiology of Blood Circulaiton. 2020; 4 (17): -

Quote as: Yudin G.V., Goncharov A.A., Rybka M.M., Dibin D.A., Lomakin M.V., Khinchagov D.Ya. Hyperlactatemia and organ dysfunction in the early postoperative period in patients with heart valves defects. Clinical Physiology of Circulation. 2020; 17 (4): 319–28 (in Russ.). DOI: 10.24022/1814-6910-2020-17-4-319-328

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Abstract

Objective. To study the frequency and character of organ dysfunction in the early postoperative period and the possibility of using serum lactate concentration as a screening-test for organ damage in patients in the first postoperative day after correction of heart valves defects.

Material and methods. A single-center retrospective study of 3919 patients who were primarily operated on heart valves. The analysis of the frequency and structure of organ dysfunction in the early postoperative period was carried out, and the ROC-analysis of the diagnostic significance of serum lactate concentration immediately after the operation and the maximum lactate concentration in the first postoperative day as a marker of organ damage was performed.

Results. The incidence of acute heart failure (AHF) was 6.6%, cerebral dysfunction (CD) – 2.8%, hepatic dysfunction (HD) – 9.1%, acute kidney injury (AKI) stage 3 AKIN (Acute Kidney Injury Network) – 2.3%, dysfunction of oxygenating lung's function – 9.8%, hemostatic system dysfunction – 0.2%, multiorgan dysfunction (MOD) – 4.6%. Postoperative mortality was 4.4%. The lactate concentration immediately after the operation 4.5 mmol/l reflected the presence of AHF with a sensitivity of 78% and specificity of 61% in other cases of organ damage the concentration of lactate after operation and the maximum level of lactatemia in the first postoperative day had a low predictive value and had a sensitivity lower than 75%, specificity lower than 64%.

Conclusion. The level of lactatemia of 4.5 mmol/l and higher immediately after the operation reflects the presence of AHF in patients with heart valves defects with sensitivity of 78%, specificity of 61%. The concentration of lactate after the operation and the maximum level of lactatemia in the first postoperative day can not be used as markers of CD, HD, AKI stage 3 AKIN, MOD in patients operated on heart valves due to their low sensitivity and specificity.

About Authors

  • Gennadiy V. Yudin, Cand. Med. Sc., Anesthesiologist-Intensivist; ORCID
  • Andrey A. Goncharov, Anesthesiologist-Intensivist; ORCID
  • Mikhail M. Rybka, Dr. Med. Sc., Professor, Head of Department of Anesthesiology; ORCID
  • Denis A. Dibin, Anesthesiologist-Intensivist; ORCID
  • Maksim V. Lomakin, Anesthesiologist-Intensivist; ORCID
  • Dzhumber Ya. Khinchagov, Cand. Med. Sc., Anesthesiologist-Intensivist; ORCID

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