An analytical observational study on the prognostic implication of postoperative serial serum lactate level for complications and predicting length of intensive therapy unit stay after major abdominal surgery

Background: Post-operative microcirculatory alteration causes hypoperfusion, tissue hypoxia and organ dysfunction, resulting in significant morbidity and mortality. Increase in serum lactate level in response to tissue hypoxia may serve as a cost effective tool to assess status of all organ dysfunction being sensitive but not organ specific and may help in early prognostication. Aim of this study was to investigate the association of blood lactate levels during the first 24 hours after surgery with postoperative morbidity and mortality, with length of ITU stay and to correlate the lactate values at various time points with different postoperative complications (POC).Methods: 150 patients undergoing elective abdominal surgery were included. Blood lactate (mmol/lit) levels were measured immediately on admission to the Intensive Therapy Unit (ITU) and at 6, 12, and 24 hours of admission. The parameters of clinical outcome included were mortality, shock, Acute kidney injury (AKI), respiratory failure, wound dehiscence and length of ITU stay. Heart Rate, Mean Arterial Pressure, spo2, Temperature and Urine output were also measured.Results: There was statistically significant difference in the lactate levels measured at the above mentioned point of time (0, 6, 12 and 24h) in cases with death and without fatal outcome, with and without respiratory failure, with and without AKI, with and without shock and in cases with and without wound dehiscence (p<0.05). There was a statistically significant difference in urine output, duration of ITU stay and duration of intubation (p<0.05).Conclusions: Increased serum lactate levels were significantly associated with postoperative complications, mortality and length of ITU stay in patients undergoing major elective abdominal surgery.

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Serum Lactate and Acute Mesenteric Ischemia: An Observational, Controlled Multicenter Study

10.21203/rs.3.rs-573044/v1 ◽

2021 ◽

Author(s):

Olivier Collange ◽

Marc LOPEZ ◽

Anne LEJAY ◽

Patrick PESSAUX ◽

Alexandre OUATTARA ◽

...

Keyword(s):

Multicenter Study ◽

Mesenteric Ischemia ◽

Acute Mesenteric Ischemia ◽

Serum Lactate ◽

Control Group ◽

Adult Intensive Care Unit ◽

Diagnosis And Prognosis ◽

Significant Difference ◽

Lactate Levels ◽

Matching Criteria

Abstract Purpose Early diagnosis of acute mesenteric ischemia (AMI) is key to survival but remains extremely difficult, as the symptoms are vague and non-specific. Although international guidelines recommend that serum lactate is not used for AMI diagnosis, this parameter is still specifically taken into account for the diagnosis and prognosis of AMI. Our hypothesis was that serum lactate levels cannot be used to diagnose AMI or predict its outcome. Methods This was an ancillary, retrospective, observational, controlled multicenter study, approved by an Ethics Committee. Patients with AMI at adult intensive care unit (ICU) admission were included (AMI group) and matched to ICU patients without AMI (control group). Matching criteria were center, period, gender, age, and severity. Serum lactate levels were measured on day 0 (D0) and day 1 (D1) and the lactate difference (D0-D1) was calculated. Results Two hundred and seventy-four patients were included. Serum lactate levels were elevated in both groups at D0 and D1 but there was no significant difference between groups at D0 (2.7 [1.3; 5.5] vs 3.4 [1.9; 6.1] mmol/L; p = 0.284), D1 (1.8 [1.2; 3.1] vs 2.4 [1.5; 4.6] mmol/L, p = 0.547; respectively for control and AMI groups) or D0-D1. Thus, the performance of serum lactate for AMI diagnosis was poor. Concerning AMI outcome, serum lactate levels predicted ICU death in both groups at D0 and D1. Conclusions no specific association was observed between serum lactate levels and AMI. Serum lactate should not be used for the diagnosis of AMI but may help assess disease severity.

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Effect of Xiangbin Prescription in Gastrointestinal Function After Gynecological Abdominal Surgery: a Randomized Controlled Trial

10.21203/rs.3.rs-660427/v1 ◽

2021 ◽

Author(s):

Yuyan Wu ◽

Jinxuan Lin ◽

Haiping Zeng ◽

Yi Chen ◽

Zhiqiang Chen ◽

...

Keyword(s):

Postoperative Complications ◽

Abdominal Surgery ◽

Controlled Trial ◽

Controlled Study ◽

Chewing Gum ◽

Control Group ◽

Gastrointestinal Function ◽

Blank Control Group ◽

Randomized Controlled ◽

Significant Difference

Abstract Background: Recovery of gastrointestinal function after gynecological abdominal surgery is a major clinical problem. An effective intervention to promote the rapid recovery of gastrointestinal function postoperatively is lacking. This randomized trial investigated whether Xiangbin prescription (XBP) was feasible in terms of efficacy and safety on gastrointestinal function recovery in patients after gynecological abdominal surgery. Methods: A randomized controlled study was conducted, in which 190 patients with gynecological abdominal surgery who met the inclusion and exclusion criteria were enrolled. They were assigned randomly to XBP group, chewing gum group or blank control group, and respectively received the following treatments: took the XBP twice a day, chewed a piece of gum for about 15 minutes each 4 hours, or received conventional western basic treatment, starting on postoperative day 1 until defecation. Three groups were compared in terms of primary outcomes including the time of the first defecation and the time of the first flatus and secondary outcomes including the level of Ghrelin (GHRL) and the incidence of postoperative complications. Meanwhile, the safety of this trial was evaluated. Results: There was no statistical difference in baseline characteristics among the three groups. For the time of the first flatus, XBP group (22.33 ± 6.68 h) showed less time compared with the chewing gum group (23.06 ± 7.37 h), while it was shorter than that in the blank control group (25.86 ± 7.93 h) with significant difference (P < 0.05). As for the time of the first defecation, XBP group (38.65 ± 12.96 h) showed shorter time significantly compared with both the chewing gum group (47.29 ± 14.50 h) and the blank control group (54.01 ± 20.32 h) (P < 0.05). For the postoperative GHRL levels, XBP group was higher than that in the chewing gum group with no significant difference and had more significant improvement of the GHRL levels at postoperative day 3 compared with the blank control group (P < 0.05). For postoperative complications, XBP group had lower incidence than the other two groups but with no significant difference. For safety evaluations, no serious adverse events occurred in the three groups. Conclusions: XBP could promote the recovery of gastrointestinal function after gynecological abdominal surgery and it is overall safe. Trial registration: This trial was retrospectively registered by Chinese Clinical Trial Registry with the identifier number, ChiCTR1900026327, at September 30, 2019. http://www.chictr.org.cn/.

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Absence of Evidence and Evidence of Absence in the FLASH Trial: A Bayesian Reanalysis

10.31234/osf.io/4pf9j ◽

2020 ◽

Author(s):

Eric-Jan Wagenmakers ◽

Quentin Frederik Gronau

Keyword(s):

Logistic Regression ◽

Postoperative Complications ◽

Abdominal Surgery ◽

Primary Outcome ◽

Kidney Injury ◽

Composite Outcome ◽

Significant Difference ◽

Volume Replacement Therapy ◽

Patients At Risk ◽

Bayesian Logistic Regression

The multicenter FLASH trial concluded that “Among patients at risk of postoperative kidney injury undergoing major abdominal surgery, use of HES [hydroxyethyl starch] for volume replacement therapy compared with 0.9% saline resulted in no significant difference in a composite outcome of death or major postoperative complications within 14 days after surgery.” Here we use Bayesian logistic regression to quantify the degree to which the data from the FLASH trial, considered in isolation, undercut the hypothesis that HES improves the primary outcome. The results show that the data from the FLASH trial mainly act to increase the plausibility that HES is ineffective, and decrease the plausibility that HES is helpful. These analysis, easily conducted in JASP (jasp-stats.org) or R (https://CRAN.R-project.org/package=abtest) arguably provide a more detailed perspective that supplements the statement that the results showed “no significant difference”.

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Role of Arterial Serum Lactate as a Predictor of Undifferentiated Shock on Admission and its Outcome- A Cohort Study

JOURNAL FOR CLINICAL AND DIAGNOSTIC RESEARCH ◽

10.7860/jcdr/2021/49761.15384 ◽

2021 ◽

Author(s):

Avadhesh Kumar Sharma ◽

Nandakumar Beke ◽

Dattatray Patki ◽

Arun Bahulikar ◽

Deepak Sadashiv Phalgune

Keyword(s):

Cohort Study ◽

Hospital Mortality ◽

Lactate Level ◽

Serum Lactate ◽

Research Centre ◽

Secondary Outcome ◽

P Value ◽

Serum Lactate Level ◽

Icu Stay ◽

Lactate Levels

Introduction: Patients with elevated serum lactate levels may be at risk for considerable morbidity and mortality and require a prompt, thoughtful and systematic approach for diagnosis and treatment. Aim: To find an association of on admission arterial serum lactate with outcome in Intensive Care Unit (ICU) patients. Materials and Methods: This observational cohort study was conducted on 168 patients at Poona Hospital and Research Centre, Pune, India, between June 2018 to November 2019 after obtaining Institutional Ethical Clearance. The patients included were above 18 years of age who had Systolic Blood Pressure (SBP) <90 mmHg, Heart Rate (HR) >100/min and Respiratory Rate (RR) >20/min. The arterial serum lactate level were examined on the day of admission, 12 hours and 24 hours. The need of ionotropic support, duration of ICU stay and mortality in one month was noted. The primary outcome measures were to study the association of on admission arterial serum lactate level with a duration of ICU stay and in-hospital mortality, whereas the secondary outcome measure was to study the association of on admission arterial serum lactate with the requirement of ionotropic support. Analysis of data was done using Statistical Package for Social Sciences for Windows, version 20.0. Results: The incidence in-hospital mortality was 20 (22.7%) out of 88 and 3 (3.8%) out of 80 in patients whose serum lactate levels on admission were >36 mg/dL and ≤36 mg/dL, respectively (p-value=0.002). The median duration of ICU stay was six and three days in patients whose serum lactate levels on admission were >36 mg/dL and ≤36 mg/dL, respectively (p-value=0.001). A 87 (98.9%) patients whose serum lactate levels >36 mg/dL on admission had the higher requirement of inotropes as compared to 35 (50.7%) patients whose serum lactate levels were ≤36 mg/dL. The percentage of patients whose serum lactate level >36 mg/dL, had a significantly higher Quick Sequential Organ Failure Assessment (qSOFA) scores and higher Shock Index (SI). There was a statistically significant positive correlation between serum lactate levels and qSOFA score (r=0.555) and SI (r=0.559). Conclusion: Initial serum lactate level was associated with higher in-hospital mortality, the higher requirement of inotropic support and longer duration of ICU stay.

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The Impact of Anti-Tumor Necrosis Factor Alpha Therapy on Postoperative Complications in Pediatric Crohn's Disease

European Journal of Pediatric Surgery ◽

10.1055/s-0039-1697909 ◽

2019 ◽

Vol 30 (01) ◽

pp. 027-032

Author(s):

Vojtech Dotlacil ◽

Jiri Bronsky ◽

Ondrej Hradsky ◽

Barbora Frybova ◽

Stepan Coufal ◽

...

Keyword(s):

Crohn’S Disease ◽

Postoperative Complications ◽

Tumor Necrosis Factor ◽

Crohn's Disease ◽

Abdominal Surgery ◽

Tumor Necrosis ◽

Tnf Α ◽

Significant Difference ◽

The Impact ◽

Necrosis Factor

Abstract Introduction The incidence of Crohn's disease (CD) within the pediatric population is increasing worldwide. Despite a growing number of these patients receiving anti-tumor necrosis factor α therapy (anti-TNF-α), one-third of them still require surgery. There is limited data as to whether anti-TNF-α influences postoperative complications. We evaluated postoperative complications in patients who were or were not exposed to anti-TNF-α therapy in our institutional cohort. Materials and Methods A retrospective review of CD patients who underwent abdominal surgery between September 2013 and September 2018 was performed. The patients were divided into two groups based on whether they were treated with anti-TNF-α within 90 days before surgery. Thirty-day postoperative complications were assessed using Clavien–Dindo classification (D-C); this examination included surgical site infections (SSIs), stoma complications, intra-abdominal septic complications, non-SSIs, bleeding, ileus, readmission rate, and return to the operating room. Mann–Whitney U-test, Fisher's exact test, and multivariate logistic regression analyses were used for statistical analysis. Results Sixty-five patients (41 males) with a median age of 16 years (range: 7–19) at the time of operation were identified. The most common surgery was ileocecal resection in 49 (75%) patients. Forty-three (66.2%) patients were treated with anti-TNF-α preoperatively. Seven patients (11%) experienced postoperative complications. There was no statistically significant difference in postoperative complication in patients who did or did not receive anti-TNF-α before surgery (D-C minor 2.3% vs. 4.6%, p = 1; D-C major 7% vs. 9.1%, p = 1). Conclusion The use of anti-TNF-α in pediatric CD patients within the 90 days prior to their abdominal surgery was not associated with an increased risk of 30-day postoperative complications.

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Evaluation of the identification protocol for newborns in a private hospital

Revista Latino-Americana de Enfermagem ◽

10.1590/s0104-11692012000400005 ◽

2012 ◽

Vol 20 (4) ◽

pp. 659-667 ◽

Cited By ~ 6

Author(s):

Ellen Regina Sevilla Quadrado ◽

Daisy Maria Rizatto Tronchin

Keyword(s):

Private Hospital ◽

Intensive Therapy ◽

Case Series ◽

Conformity Index ◽

Intensive Therapy Unit ◽

Second Stage ◽

Significant Difference ◽

Three Stages ◽

Random Probability

This exploratory-descriptive quantitative study aimed to evaluate the protocol for identifying newborns admitted to the Neonatal Intensive and Semi-intensive Therapy Unit of a private hospital. The case series was made up of 540 observation opportunities, selected by simple random probability sampling. The data was collected between May and August 2010 according to a form and analyzed by descriptive statistic. The protocol's general performance had a conformity index of 82.2%. There were three stages to the protocol: identification components, the identification wristbands' condition and the number of identification wristbands. The highest percentage of conformity (93%) was attributed to the second stage and the lowest (89.3%) to the third, presenting a statistically significant difference of p= 0.046. In the group of 'special' neonates, 88.5% conformity was achieved. These results will make it possible to restructure the protocol for identifying newborns and to establish care and managerial goals so as to improve the quality of care and the patients' safety.

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Serum Lactate Level as a Predictor for Blood Transfusion in Postpartum Hemorrhage

American Journal of Perinatology ◽

10.1055/s-0041-1740009 ◽

2021 ◽

Author(s):

Surbhi Agrawal ◽

Maria Smith ◽

Robert Berg ◽

Iffath A. Hoskins

Keyword(s):

Blood Transfusion ◽

Postpartum Hemorrhage ◽

Lactate Level ◽

Serum Lactate ◽

Normal Serum ◽

Red Blood Cell Transfusion ◽

Blood Transfusions ◽

Serum Lactate Level ◽

Obstetric Hemorrhage ◽

Lactate Levels

Objective Postpartum hemorrhage (PPH) is the leading cause of maternal morbidity and mortality. At present, there are no reliable clinical or laboratory indicators to identify which patients might require blood transfusions during a PPH. Serum lactate has long been used as an early biomarker of tissue hypoperfusion in trauma settings. The aim of this study is to understand serum lactate's role in the management of obstetric hemorrhage. Study Design A retrospective chart review was performed of women who delivered between 2016 and 2019 at our institution and experienced a PPH. The patients were divided into two groups: those with a normal serum lactate level, defined as ≤2 mmol/L, and those with an abnormal serum lactate level, defined as >2 mmol/L. Need for packed red blood cell transfusion, as part of the resuscitation, was assessed for both groups. Results During the study period, 938 women experienced PPH. Of these, 108 (11.5%) had a normal serum lactate, ≤2 mmol/L, and 830 (88.5%) had an abnormal lactate, >2 mmol/L. Women with elevated lactate levels were more likely to receive a blood transfusion versus those with a normal lactate level (57.0 vs. 46.3%, p = 0.035, respectively). Additionally, the average number of blood transfusions administered was significantly higher in the abnormal lactate group versus in the normal lactate group (1.34 vs. 0.97, respectively, p = 0.004). In a multivariable linear regression model, increasing serum lactate levels were found to be predictive of requiring more than 1 unit of blood (p < 0.001). Conclusion Women with elevated serum lactate levels were more likely to require blood transfusions during a PPH versus those with a normal serum lactate level. Thus, serum lactate levels are useful as an early indicator of requirement for blood transfusion in the management of obstetric hemorrhage. Key Points

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Plasma Cysteine and Sulphate Levels in Patients with Cirrhosis of the Liver

Clinical Science ◽

10.1042/cs0870357 ◽

1994 ◽

Vol 87 (3) ◽

pp. 357-362 ◽

Cited By ~ 8

Author(s):

M. H. Davies ◽

L. Klovrza ◽

R. H. Waring ◽

E. Elias

Keyword(s):

Liver Disease ◽

Primary Biliary Cirrhosis ◽

Intensive Therapy ◽

Biliary Cirrhosis ◽

Intensive Therapy Unit ◽

Control Subjects ◽

Significant Difference ◽

Catabolic State ◽

Healthy Control ◽

Muscle Breakdown

1. Fasting levels of plasma cysteine, plasma sulphate and the plasma cysteine/sulphate ratio were measured in patients with primary biliary cirrhosis and compared with those in patients with other liver disease, general intensive therapy unit patients and healthy subjects. 2. Plasma cysteine was significantly elevated in patients with primary biliary cirrhosis (median 0.364 nmol/mg of protein, P < 0.0001) and patients with other liver disease (median 0.445 nmol/mg of protein, P < 0.0001), compared with healthy control subjects (median 0.125 nmol/mg of protein) and increased progressively with the severity of liver disease. Plasma cysteine was also elevated in intensive therapy unit patients (median 1.564 nmol/mg of protein) compared with healthy control subjects (P < 0.0001) and patients with other liver disease (P < 0.0001). 3. Plasma sulphate was reduced significantly only in patients with primary biliary cirrhosis (median 0.822 nmol/mg of protein) compared with healthy control subjects (median 1.37 nmol/mg of protein, P < 0.05). There was no significant difference in plasma sulphate between disease groups. 4. The plasma cysteine/sulphate ratio was significantly elevated in patients with primary biliary cirrhosis (median 0.448, P < 0.0001) and patients with other liver diseases (median 0.394, P < 0.0001) compared with healthy control subjects (median 0.095). The ratio was also elevated in intensive therapy unit patients (median 1.650, P < 0.0001) compared with healthy control subjects and liver disease groups (P < 0.0001). 5. In conclusion, plasma cysteine rises in primary biliary cirrhosis and other forms of liver disease. This effect is not specific to liver disease, since cysteine is elevated in an heterogeneous group receiving intensive care. Impairment of trans-methylation and trans-sulphuration pathways does not explain the finding of increased plasma cysteine. Since cysteine is elevated in non-hepatic disease, it may reflect the effect of muscle breakdown and the catabolic state. Impaired activity of cysteine dioxygenase and impaired mitochondrial function may be contributory, but this requires further study. These metabolic changes may reflect progressively diminished detoxification capacity within the liver and other tissues.

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206. The Utility of Lactate as a Biomarker for Sepsis in Cancer Patients

Open Forum Infectious Diseases ◽

10.1093/ofid/ofaa439.250 ◽

2020 ◽

Vol 7 (Supplement_1) ◽

pp. S106-S107

Author(s):

Suji Mathew ◽

Leah Whitman

Keyword(s):

Liver Metastasis ◽

Lactic Acidosis ◽

Cancer Patients ◽

Antimicrobial Stewardship ◽

Antibiotic Use ◽

Lactate Clearance ◽

Serum Lactate ◽

Liver Involvement ◽

Significant Difference ◽

Lactate Levels

Abstract Background Serum lactate is included in the initial assessment of patients with sepsis. However, cancer patients develop lactic acidosis for a variety of reasons and are underrepresented in most studies. Therefore, elevated lactate levels may lead to overdiagnosis of sepsis and excessive antibiotic use. The purpose of this study is to evaluate the utility of lactate as a biomarker for sepsis in cancer patients. The primary endpoint is the rate of 24-hour lactate clearance between infectious and non-infectious causes of lactic acidosis in cancer patients. Secondary objectives explore the duration of antibiotic therapy (DOT), the impact of liver metastasis on serum lactate levels, and the role of procalcitonin in distinguishing between infectious and non-infectious causes of lactic acidosis. Methods Retrospective chart review by Antimicrobial Stewardship team Figure 1: Study design Results Preliminary data from a random subset of our sample (45/150) suggests there is no difference in mean serum lactate levels between infectious and non-infectious groups (4.6 vs 6.4). However, a substantial difference exists in the rate of 24h lactate clearance, although the difference was not statistically significant (58.3% vs 33%; p=0.13) (Fig2). There was a significant difference in antibiotic DOT (12.6 vs 3.3; p< 0.0001) presumably due to robust antimicrobial stewardship practices. Consistent with previous studies, there was a significant difference in procalcitonin levels between groups (27.2 vs 1.5, p=0.04). A sub-analysis of non-infectious patients with liver metastasis revealed a statistically significant difference in the rate of lactate clearance (21% vs 61.5%, p=0.03) (Fig3) suggesting that liver involvement impacts lactate clearance. Antibiotic DOT were also longer in non-infectious patients with liver metastasis (4.53 vs 1.38, p=0.02). Comparing end points between cancer patients with and witthout infection. Liver involvement affecting Lactate clearance in patients without infection. Conclusion Cancer patients often manifest SIRS criteria at baseline which may lead to the overdiagnosis of infection and excessive antibiotic usage. Our observation is that lactate clearance as opposed to degree of lactic acidosis may be a more accurate indicator of infection in cancer patients especially those with liver involvement. This information may mitigate unnecessary antibiotic use in cancer patients with persistent lactic acidosis unrelated to infection. Disclosures All Authors: No reported disclosures

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Pre-term Infants in Major Abdominal Surgery and Postoperative Outcome

10.21203/rs.3.rs-669064/v1 ◽

2021 ◽

Author(s):

Claudine Kumba

Keyword(s):

Respiratory Failure ◽

Postoperative Complications ◽

Observational Study ◽

Abdominal Surgery ◽

Secondary Analysis ◽

Postoperative Outcome ◽

Surgical Wound ◽

Wound Sepsis ◽

Term Infants ◽

Initial Cohort

Abstract Background: A monocentric observational study was undertaken in pediatric surgical patients in neurosurgery, abdominal and orthopedic surgery to determine predictors of postoperative outcome. In this cohort of 594 patients with a mean age of 90.86±71.80 months there were 25 pre-terms aged less than 37 weeks. A description of postoperative outcome was undertaken in these pre-term infants. Objective: The objective of this study was to describe the characteristics in pre-term patients in this initial cohort. Methods: Secondary analysis of pre-term patients included in the initial retrospective observational study. The Ethics Committee approved the study. Results: 25 pre-terms aged <37 weeks were included with a mean weight of 2.43±0.75 kg in major neonatal abdominal surgery. 9 patient presented postoperative complications among which 1 had an intra-operative cardiac arrest, 4 had postoperative respiratory failure, 2 had pulmonary sepsis, 1 had surgical wound sepsis, 1 had septicemia and 1 had multi-organ sepsis. Conclusion: In this cohort of 25 critically ill pre-terms in major neonatal abdominal surgery, the most common postoperative complications concerned the respiratory system which included respiratory failure and pulmonary sepsis. There was no in-hospital mortality.

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