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. 2022 May 10;10(5):1108.
doi: 10.3390/biomedicines10051108.

High Arterial Lactate Levels after Hepatic Resection Are Associated with Low Oxygen Delivery and Predict Severe Postoperative Complications

Rita Gaspari  1   2 , Luciana Teofili  3   4 , Francesco Ardito  5   6 , Enrica Adducci  1   2 , Maria Vellone  5   6 , Caterina Mele  5 , Nicoletta Orlando  3 , Tiziana Iacobucci  1 , Massimo Antonelli  1   2 , Felice Giuliante  5   6
Affiliations

High Arterial Lactate Levels after Hepatic Resection Are Associated with Low Oxygen Delivery and Predict Severe Postoperative Complications

Rita Gaspari et al. Biomedicines. .

Abstract

High End-Surgery Arterial Lactate Concentration (ES-ALC) predicts poor outcome after hepatectomy. The aim of this study was to identify intraoperative hemodynamic parameters predicting high ES-ALC during elective liver resection. Patients who underwent liver resection between 2017 and 2018, under FloTrac/EV1000TM hemodynamic monitoring, were included. The ES-ALC cutoff best predicting severe postoperative complications was identified. Association between high ES-ALC and preoperative and intraoperative variables was assessed. 108 patients were included; 90-day mortality was 0.9% and severe morbidity 14.8%. ES-ALC cutoff best discriminating severe complications was 5.05 mmol/L. Patients with ES-ALC > 5.0 mmol/L had a relative risk of severe complications of 2.8% (p = 0.004). High ES-ALC patients had longer surgery and ischemia duration, larger blood losses and higher requirements of fluids and blood transfusions. During surgery, hemoglobin concentration and oxygen delivery (DO2) decreased more significantly in patients with high ES-ALC, although they had similar values of stroke volume and cardiac output to those of other patients. At multivariate analysis, surgery duration and lowest recorded DO2 value were the strongest predictors of high ES-ALC. ES-ALC > 5.0 mmol/L in elective liver resection predicts postoperative morbidity and is essentially driven by the impaired DO2. Timely correction of blood losses might prevent the ES-ALC increase.

Keywords: anemia; hemodynamic monitoring; hepatectomy; hyperlactatemia; oxygen delivery; postoperative complications.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
ROC curve analysis of post-operative lactate levels for the occurrence of severe complications. The optimal cut-off value was 5.05 mmol/L, with an area under the curve of 0.661 ± 0.079 (95% CI 0.506–0.816), a sensitivity of 0.563, and a specificity of 0.804.
Figure 2
Figure 2
Linear regression analysis pairing lactate levels with drop of blood losses (A), Hb concentration (B), fluid administration (C), and surgery duration (D).
Figure 3
Figure 3
Paired analysis of initial, lowest, and end-surgery levels of oxygen delivery, stroke volume, cardiac output, and hemoglobin concentration in patients grouped according to end-surgery lactate level (≤ or >5 mmol/L). (ns, not significant).
See this image and copyright information in PMC

References

    1. Seheult J., Fitzpatrick G., Boran G. Lactic acidosis: An update. Clin. Chem. Lab. Med. 2017;55:322–333. doi: 10.1515/cclm-2016-0438. - DOI - PubMed
    1. Watanabe I., Mayumi T., Arishima T., Takahashi H., Shikano T., Nakao A., Nagino M., Nimura Y., Takezawa J. Hyperlactemia can predict the prognosis of liver resection. Shock. 2007;28:35–38. doi: 10.1097/shk.0b013e3180310ca9. - DOI - PubMed
    1. Wiggans M.G., Starkie T., Shahtahmassebi G., Woolley T., Birt D., Erasmus P., Anderson I., Bowles M.J., Aroori S., Stell D.A. Serum Arterial Lactate Concentration Predicts Mortality and Organ Dysfunction Following Liver Resection. Perioper. Med. 2013;2:21. doi: 10.1186/2047-0525-2-21. - DOI - PMC - PubMed
    1. Vibert E., Boleslawski E., Cosse C., Adam R., Castaing D., Cherqui D., Naili S., Régimbeau J.M., Cunha A.S., Truant S., et al. Arterial lactate concentration at the end of an elective hepatectomy is an early predictor of the postoperative course and a potential surrogate of intraoperative events. Ann. Surg. 2015;262:787–793. doi: 10.1097/SLA.0000000000001468. - DOI - PubMed
    1. Meguro M., Mizuguchi T., Kawamoto M., Nishidate T., Ishii M., Tatsumi H., Kimura Y., Furuhata T., Hirata K. Highest intraoperative lactate level could predict postoperative infectious complications after hepatectomy, reflecting the Pringle maneuver especially in chronic liver disease. J. Hepatobiliary Pancreat. Sci. 2014;21:489–498. doi: 10.1002/jhbp.87. - DOI - PubMed

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