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Preoperative arterial lactate and outcome after surgery for type A aortic dissection: The ERTAAD multicenter study.

Preoperative arterial lactate and outcome after surgery for type A aortic dissection: The ERTAAD multicenter study.

Authors :
Biancari F
Nappi F
Gatti G
Perrotti A
Hervé A
Rosato S
D'Errigo P
Pettinari M
Peterss S
Buech J
Juvonen T
Jormalainen M
Mustonen C
Demal T
Conradi L
Pol M
Kacer P
Dell'Aquila AM
Wisniewski K
Vendramin I
Piani D
Ferrante L
Mäkikallio T
Quintana E
Pruna-Guillen R
Fiore A
Folliguet T
Mariscalco G
Acharya M
Field M
Kuduvalli M
Onorati F
Rossetti C
Gerelli S
Di Perna D
Mazzaro E
Pinto AG
Lega JR
Rinaldi M
Source :
Heliyon [Heliyon] 2023 Oct 05; Vol. 9 (10), pp. e20702. Date of Electronic Publication: 2023 Oct 05 (Print Publication: 2023).
Publication Year :
2023

Abstract

Background: Acute type A aortic dissection (TAAD) is associated with significant mortality and morbidity. In this study we evaluated the prognostic significance of preoperative arterial lactate concentration on the outcome after surgery for TAAD.<br />Methods: The ERTAAD registry included consecutive patients who underwent surgery for acute type A aortic dissection (TAAD) at 18 European centers of cardiac surgery.<br />Results: Data on arterial lactate concentration immediately before surgery were available in 2798 (71.7 %) patients. Preoperative concentration of arterial lactate was an independent predictor of in-hospital mortality (mean, 3.5 ± 3.2 vs 2.1 ± 1.8 mmol/L, adjusted OR 1.181, 95%CI 1.129-1.235). The best cutoff value preoperative arterial lactate concentration was 1.8 mmol/L (in-hospital mortality, 12.0 %, vs. 26.6 %, p < 0.0001). The rates of in-hospital mortality increased along increasing quintiles of arterial lactate and it was 12.1 % in the lowest quintile and 33.6 % in the highest quintile (p < 0.0001). The difference between multivariable models with and without preoperative arterial lactate was statistically significant (p = 0.0002). The NRI was 0.296 (95%CI 0.200-0.391) (p < 0.0001) with -17 % of events correctly reclassified (p = 0.0002) and 46 % of non-events correctly reclassified (p < 0.0001). The IDI was 0.025 (95%CI 0.016-0.034) (p < 0.0001). Six studies from a systematic review plus the present one provided data for a pooled analysis which showed that the mean difference of preoperative arterial lactate between 30-day/in-hospital deaths and survivors was 1.85 mmol/L (95%CI 1.22-2.47, p < 0.0001, I <superscript>2</superscript> 64 %).<br />Conclusions: Hyperlactatemia significantly increased the risk of mortality after surgery for acute TAAD and should be considered in the clinical assessment of these critically ill patients.<br />Competing Interests: The authors declare the following financial interests/personal relationships which may be considered as potential competing interests:Fausto Biancari reports financial support was provided by 10.13039/501100005633Finnish Foundation for Cardiovascular Research. Fausto Biancari reports financial support was provided by Sigrid Jusélius Foundation.<br /> (© 2023 The Authors.)

Details

Language :
English
ISSN :
2405-8440
Volume :
9
Issue :
10
Database :
MEDLINE
Journal :
Heliyon
Publication Type :
Academic Journal
Accession number :
37829811
Full Text :
https://doi.org/10.1016/j.heliyon.2023.e20702