Clinical Physiology of Circulation

ISSN 1814-6910 (Print)
ISSN 2410-9134 (Online)

 

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


Issue's catalogue ➤ КФК. 2021; 18 (2): 93-180 ➤ Послеоперационная адреналининдуцированная гиперлактатемия у больных, оперируемых по поводу приобретенных пороков сердца

Postoperative adrenalineinduced hyperlactatemia in patients undergoing surgical correction of heart valves defects

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

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

E-mail: Сведения доступны для зарегистрированных пользователей.

DOI: https://doi.org/10.24022/1814-6910-2021-18-2-149-157

UDC: 616.12-007.1-083.98:615.217.24

Link: Clinical Physiology of Blood Circulaiton. 2021; 2 (18): 149-157

Quote as: Yudin G.V., Goncharov A.A., Rybka M.M., Lomakin M.V., Dibin D.A. Postoperative adrenaline-induced hyperlactatemia in patients undergoing surgical correction of heart valves defects. Clinical Physiology of Circulation. 2021; 18 (2): 149–57 (in Russ.). DOI: 10.24022/1814-6910-2021-18-2-149-157

Keywords:  hyperlactatemia adrenaline heart valves defects

Received / Accepted:  09.04.2021 / 01.05.2021

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Abstract

Objective. To determine the predictor significance of serum lactate concentration as a marker of adrenaline-induced hyperlactatemia in patients undergoing surgical correction of heart valves defects.

Material and methods. A retrospective cohort study involving 1020 patients initially operated on heart valves, divided into two groups depending on the profile of inotropic support: the dobutamine group (n = 495) and the adrenaline group (n = 525). The study excluded patients whose intra- and early postoperative period was complicated by the development of acute heart failure, organ dysfunction, and blood loss of more than 1000 ml. A comparative analysis of the serum lactate concentration after the end of the operation and its maximum concentration in the first postoperative day was performed, and their predictor significance as a marker of adrenaline-induced hyperlactatemia was revealed on the basis of regression analysis.

Results. In the adrenaline group higher serum lactate concentrations were observed after the operation, 5.1 ± 3.4 mmol/l versus 1.7 ± 1.4 mmol/l in the dobutamine group (p < 0.0001), and its maximum concentration in the first postoperative day, 8.7 ± 5.0 mmol/l versus 3.0±2.7 mmol/l in the dobutamine group (p < 0.0001). As a marker of adrenaline-induced hyperlactatemia, the concentration of serum lactate after surgery was 2.6 mmol/l with a sensitivity of 82% and a specificity of 80% (AUC 0.87; CI 0.85–0.9) and the maximum level of lactatemia in the first postoperative day of 7.1 mmol/l with a sensitivity of 61%, specificity of 90% (AUC 0.8; CI 0.78–0.83).

Conclusion. In the case of uncomplicated course of intraoperative and early postoperative periods during inotropic adrenaline support in patients operated on heart valves, hyperlactatemia with a serum lactate concentration after the operation of 2.6 mmol/l and its maximum concentration on the first postoperative day of 7.1 mmol/l has an adrenaline-induced character.

References

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  1. Arora R.C., Singal R.K. Severe hyperlactatemia after cardiac surgery: sorting out the badness. J. Thorac. Cardiovasc. Surg. 2016; 151 (3): 830–1. DOI: 10.1016/j.jtcvs.2015.11.037
  2. Jakob S.M., Stanga Z. Perioperative metabolic changes in patients undergoing cardiac surgery. Nutrition. 2010; 26 (4): 349–53. DOI: 10.1016/j.nut.2009.07.014
  3. Ezaka M., Tsukamoto J., Matsuo K., Kin N., Yamaoka K. Hyperlactatemia of dialysis-dependent patients after cardiac surgery impacts on in-hospital mortality: a twocenter retrospective study. JA Clin. Rep. 2020; 6 (1): 47. DOI: 10.1186/s40981-020-00348-1
  4. Kogan A., Cohen J., Raanani E., Sahar G., Orlov B., Singer P. et al. Readmission to the intensive care unit after "fast-track" cardiac surgery: risk factors and outcomes. Ann. Thorac. Surg. 2003; 76 (2): 503–7. DOI: 10.1016/s0003-4975(03)00510-1
  5. Maillet J.M., Le Besnerais P., Cantoni M., Nataf P., Ruffenach A., Lessana A. et al. Frequency, risk factors, and outcome of hyperlactatemia after cardiac surgery. Chest. 2003; 123 (5): 1361–6. DOI: 10.1378/chest.123.5.1361
  6. Callaway D.W., Shapiro N.I., Donnino M.W., Baker C., Rosen C.L. Serum lactate and base deficit as predictors of mortality in normotensive elderly blunt trauma patients. J. Trauma. 2009; 66 (4): 1040–4. DOI: 10.1097/TA.0b013e3181895e9e
  7. Bou Chebl R., El Khuri C., Shami A., Rajha E., Faris N., Bachir R. et al. Serum lactate is an independent predictor of hospital mortality in critically ill patients in the emergency department: a retrospective study. Scand. J. Trauma. Resusc. Emerg. Med. 2017; 25 (1): 69. DOI: 10.1186/s13049-017-0415-8
  8. Haas S.A., Lange T., Saugel B., Petzoldt M., Fuhrmann V., Metschke M. et al. Severe hyperlactatemia, lactate clearance and mortality in unselected critically ill patients. Intensive Care Med. 2016; 42 (2): 202–10. DOI: 10.1007/s00134-015-4127-0
  9. Bernhard M., Döll S., Kramer A., Weidhase L., Hartwig T., Petros S. et al. Elevated admission lactate levels in the emergency department are associated with increased 30-day mortality in non-trauma critically ill patients. Scand. J. Trauma. Resusc. Emerg. Med. 2020; 28 (1): 82. DOI: 10.1186/s13049-020-00777-y
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  18. Blohm E., Lai J., Neavyn M. Drug-induced hyperlactatemia. Clin. Toxicol. (Phila). 2017; 55 (8): 869–78. DOI: 10.1080/15563650.2017.1317348
  19. Smith Z.R., Horng M., Rech M.A. Medicationinduced hyperlactatemia and lactic acidosis: a systematic review of the literature. Pharmacotherapy. 2019; 39 (9): 946–63. DOI: 10.1002/phar.2316
  20. Bundgaard H., Kjeldsen K., Suarez Krabbe K., van Hall G., Simonsen L., Qvist J. et al. Endotoxemia stimulates skeletal muscle Na+-K+-ATPase and raises blood lactate under aerobic conditions in humans. Am. J. Physiol. Heart Circ. Physiol. 2003; 284 (3): H1028–34. DOI: 10.1152/ajpheart.00639.2002
  21. Levy B., Gibot S., Franck P., Cravoisy A., Bollaert P.E. Relation between muscle Na+K+ ATPase activity and raised lactate concentrations in septic shock: a prospective study. Lancet. 2005; 365 (9462): 871–5. DOI: 10.1016/S0140-6736(05)71045-X
  22. Vincent J.L., Quintairos e Silva A., Couto L. Jr., Taccone F.S. The value of blood lactate kinetics in critically ill patients: a systematic review. Crit. Care. 2016; 20 (1): 257. DOI: 10.1186/s13054-016-1403-5

About Authors

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

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