Lactate non-clearance versus lactate clearance : a comparison of hospital mortality in high-risk surgical patients

Abstract

Objective: The optimal endpoints of resuscitation in high-risk surgical patients remain controversial. Specifically, it is difficult to establish the effective predictive markers as the endpoints of resuscitation in this patient group. Therefore, the study was conducted to assess the predictive value of early lactate non-clearance condition on hospital mortality in high-risk surgical patients. Materials and Methods: The study is a prospective analytic study. The data was collected in one university-based surgical intensive care unit (SICU) over a 5-month period. All consecutive adult high-risk surgical patients admitted to SICU in postoperative period were recruited to the study. Blood lactate levels were measured on SICU admission (0-hour), 12 hours later, and then calculated for 12-hour blood lactate clearance. The authors categorized the patients into two groups: lactate clearance (LC) and lactate non-clearance (LNC). After that, the patients were monitored until hospital discharge or in-hospital death. Results: 122 high-risk surgical patients were recruited to the study. The most common indication for SICU admission was extensive ablative surgery for carcinoma. As concerns the factors of interest, higher incidences of suspected or confirmed infection and mechanical ventilation were found among the LNC group. Regarding the main outcomes, hospital mortality was 5.3% among the LNC group and 3.9% among the LC group (p = 0.578), with no statistical significant differences in hospital mortality, hospital length of stay and SICU length of stay. The independent risk factors associated with LNC condition were considered. The factor of interest was suspected or confirmed infection by multiple logistic regression analysis after adjustment for age and sex revealed that the adjusted odds ratio was 2.70 with a 95% confidence interval of 0.85-8.55, p = 0.092. Conclusion: 12-hour LNC in high-risk surgical patients cannot demonstrate the prognostic value for hospital morbidity and mortality. However, there is a trend for the suspected or confirmed infection group to associate with the LNC condition but with no statistical significance.