arterial lactate level
Recently Published Documents


TOTAL DOCUMENTS

17
(FIVE YEARS 7)

H-INDEX

5
(FIVE YEARS 1)

2021 ◽  
Author(s):  
Antoine Epin ◽  
Guillaume Passot ◽  
Niki Christou ◽  
Olivier Monneuse ◽  
Jean-Yves Mabrut ◽  
...  

Abstract Background: Gastric pneumatosis (GP) is a rare radiologic finding with an unpredictable prognosis. The aim of this study was to identify mortality risk factors from patients presenting with GP on computed tomography (CT), and to develop a model which would allow us to predict which patients would benefit most from operative management.Methods: Between 2010 and 2020, all CT-scan reports in 4 tertiary centers were searched for the following terms: “gastric pneumatosis”, “intramural gastric air” or “emphysematous gastritis”. The retrieved CT scans were reviewed by a senior surgeon and a senior radiologist. Relevant clinical and laboratory data for these patients were extracted from the institutions’ medical records. Results: Among 58 patients with GP portal venous gas and bowel ischemia were present on CT scan in 52 (90%) and 17 patients (29%), respectively. The 30-day mortality rate was 31%. Univariate analysis identified the following variables as predictive of mortality at the time of the diagnosis of GP: abdominal guarding, hemodynamic instability, arterial lactate level >2mmol/l, and absence of gastric dilatation. Multivariable analysis identified the following variables as independent predictors of mortality: arterial lactate level (OR: 1.39, 95% CI: 1.07 - 1.79) and absence of gastric dilatation (OR: 0.07, 95% CI: 0.01 - 0.79). None of the patients presenting with a baseline lactate rate <2 mmol/l died within 30 days following diagnosis, and no more than 17 patients out of 58 had bowel ischemia (29%).Conclusions: GP could be managed non-operatively, even in the presence of portal venous gas. However patients with arterial lactate level>2mmol/l, or absence of gastric dilation should be surgically explored due to a non-negligible risk of mortality.


2021 ◽  
Vol 10 (Supplement_1) ◽  
Author(s):  
M Laimoud ◽  
M Alanazi

Abstract Funding Acknowledgements Type of funding sources: None. Background Veno-Arterial ECMO is  a life  supporting procedure that can be done to the patients with cardiogenic shock which is associated with hyperlactatemia . The objective of this study was to detect the validity of serial measurements of arterial lactate level in differentiating hospital mortality and neurological outcome  after VA-ECMO support. Results : This retrospective study included 106 patients between 2015 and 2019 with a mean age of  40.2 ± 14.4 years and mostly males (69.8%) . The in-hospital mortality occurred in 56.6% and acute strokes occurred in 25.5% of the patients . The non-survivors and the patients with acute strokes  had significantly higher arterial  lactate levels at pre-ECMO initiation , post-ECMO peak and after 24 hours of ECMO support compared to the survivors and those without strokes respectively.  The peak arterial lactate  ≥ 14.65 mmol/L measured  after  ECMO support  had 81.7 % sensitivity and 89.1 % specificity for predicting hospital mortality  [AUROC: 0.889 , p &lt;0.001 ] while the arterial lactate level ≥ 3.25 mmol/L after 24 hours of ECMO support had  88.3% sensitivity and 97.8% specificity for predicting hospital mortality  [AUROC: 0.93 , p &lt;0.001 ]. The peak lactate  ≥ 15.15 mmol/L  measured  after  ECMO support  had 70.8 % sensitivity and 69 % specificity for predicting cerebral strokes [AUROC: 0.717 , p &lt;0.001 ] while the lactate level ≥ 3.25 mmol/L after 24 hours of ECMO support had  79.2% sensitivity and 72.4% specificity for predicting cerebral strokes [AUROC: 0.779, p &lt;0.001 ]. Progressive hyperlactatemia (OR = 1.427  , 95% CI : 1.048 – 1.944 , p = 0.024 ) and increasing  SOFA score after 48 hours  (OR = 1.819 , 95% CI : 1.374 – 2.409 , p &lt; 0.001) were significantly associated with in-hospital mortality after VA-ECMO support. Conclusion : Progressive hyperlactatemia after VA-ECMO initiation for adult patients with cardiogenic shock is a sensitive and specific predictor of hospital mortality and acute cerebrovascular strokes  . According to our results , we could recommend early VA-ECMO initiation to achieve adequate circulatory support and better outcome. Predictors of hospital mortality.Studied variablesP valueOR95% CI for ORLactate peak0.0241.4271.048 - 1.944Hemodialysis0.3154.1260.344 - 51.669Atrial fibrillation0.073.2680.786 - 31.26Cardiac surgeries0.2173.4820.480 - 25.152Δ SOFA&lt;0.0011.8191.374 - 2.409Central VA-ECMO0.123.9310.482 - 24.16Abstract Figure. ROC of lactate differentiating mortality


2020 ◽  
Vol 72 (1) ◽  
Author(s):  
Mohamed Laimoud ◽  
Mosleh Alanazi

Abstract Background Veno-arterial ECMO is a life-supporting procedure that can be done to the patients with cardiogenic shock which is associated with hyperlactatemia. The objective of this study was to detect the validity of serial measurements of arterial lactate level in differentiating hospital mortality and neurological outcome after VA-ECMO support for adult patients with cardiogenic shock. All consecutive patients ≥ 18 years admitted with cardiogenic shock and supported with VA-ECMO between 2015 and 2019 in our tertiary care hospital were retrospectively studied. Results The study included 106 patients with a mean age of 40.2 ± 14.4 years, a mean BMI of 26.5 ± 7 and mostly males (69.8%). The in-hospital mortality occurred in 56.6% and acute cerebral strokes occurred in 25.5% of the enrolled patients. The non-survivors and the patients with acute cerebral strokes had significantly higher arterial lactate levels at pre-ECMO initiation, post-ECMO peak and after 24 h of ECMO support compared to the survivors and those without strokes, respectively. The peak arterial lactate ≥ 14.65 mmol/L measured after ECMO support had 81.7% sensitivity and 89.1% specificity for predicting hospital mortality [AUROC 0.889, p < 0.001], while the arterial lactate level ≥ 3.25 mmol/L after 24 h of ECMO support had 88.3% sensitivity and 97.8% specificity for predicting hospital mortality [AUROC 0.93, p < 0.001]. The peak lactate ≥ 15.15 mmol/L measured after ECMO support had 70.8% sensitivity and 69% specificity for predicting cerebral strokes [AUROC 0.717, p < 0.001], while the lactate level ≥ 3.25 mmol/L after 24 h of ECMO support had 79.2% sensitivity and 72.4% specificity for predicting cerebral strokes [AUROC 0.779, p < 0.001]. Progressive hyperlactatemia (OR = 1.427, 95% CI 1.048–1.944, p = 0.024) and increasing SOFA score after 48 h (OR = 1.819, 95% CI 1.374–2.409, p < 0.001) were significantly associated with in-hospital mortality after VA-ECMO support. Post hoc analysis detected a significantly high frequency of hypoalbuminemia in the non-survivors and in the patients who developed acute cerebral strokes during VA-ECMO support. Conclusion Progressive hyperlactatemia after VA-ECMO initiation for adult patients with cardiogenic shock is a sensitive and specific predictor of hospital mortality and acute cerebrovascular strokes. According to our results, we could recommend early VA-ECMO initiation to achieve adequate circulatory support and better outcome.


2020 ◽  
Vol 24 (8) ◽  
pp. 672-676
Author(s):  
Arnaud Ferraris ◽  
Camille Bouisse ◽  
Fabrice Thiollière ◽  
Vincent Piriou ◽  
Bernard Allaouchiche

2017 ◽  
Vol 61 (3) ◽  
pp. 58
Author(s):  
M. C. Haanschoten ◽  
H. G. Kreeftenberg ◽  
R. Arthur Bouwman ◽  
A. H. van Straten ◽  
W. F. Buhre ◽  
...  

2017 ◽  
Vol 31 (1) ◽  
pp. 45-53 ◽  
Author(s):  
Marco C. Haanschoten ◽  
Herman G. Kreeftenberg ◽  
R. Arthur Bouwman ◽  
Albert H.M. van Straten ◽  
Wolfgang F. Buhre ◽  
...  

Sign in / Sign up

Export Citation Format

Share Document