Base excess is superior to lactate-levels in prediction of ICU mortality after cardiac surgery

• Published in: PloS one Vol. 13; no. 10; p. e0205309
• Main Authors: Zante, Bjoern, Reichenspurner, Hermann, Kubik, Mathias, Kluge, Stefan, Schefold, Joerg C, Pfortmueller, Carmen A
• Format: Journal Article
• Language: English
• Published: United States Public Library of Science 05-10-2018; Public Library of Science (PLoS)
• Subjects: Acid-base status; Anesthesiology; Cardiac patients; Chronic obstructive pulmonary disease; Emergency medical care; Health aspects; Heart; Heart surgery; Hospitals; Hyperlactatemia; Intensive care; Intensive care units; Lactates; Lactic acid; Medicine; Medicine and Health Sciences; Metabolism; Mortality; Patients; Physical Sciences; Pulmonary arteries; Regression analysis; Regression models; Research and Analysis Methods; Sensitivity; Services; Statistical analysis; Subgroups; Surgery; Systematic review; Trauma; Switzerland; Germany
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0205309

Cardiac surgery with the use of cardiopulmonary bypass is known to induce distinct metabolic changes. Respective changes in acid-base status including increased systemic lactate levels were previously related to clinical outcomes, but data remain controversial. Therefore, we aim to investigate the relevance of lactate and base excess (BE) levels on ICU-mortality in patients admitted to the ICU after cardiac surgery.
Perioperative data of patients treated in a tertiary care academic center admitted to the ICU after on-pump surgery were analyzed in a retrospective fashion. Receiver operation characteristic (ROC) curves were constructed for admission lactate-levels and BE with calculation of optimal cut-off values to predict ICU mortality. Univariate followed by multivariate regression models were constructed to identify potential outcome-relevant indices.
Data from 1,058 patients were included in the analysis. Area under the curves for prediction of ICU mortality were 0.79 for lactate levels at ICU admission (sensitivity 61.9%/ specificity 87.5%; optimal cut-off level 3.9mmol/l), and 0.7 for BE (sensitivity 52.4%/ specificity 93.8%, optimal cut-off level -6.7), respectively. Multivariate regression identified BE < -6.7 as the single metabolic predictor of ICU-mortality (HR 4.78, 95%-CI 1.4-16.33, p = 0.01). Explorative subgroup analyses revealed that the combination of lactate ≤3.9mmol/l and BE ≤ -6.7 has stronger impact on mortality than a combination of lactate of >3.9mmol/l and BE > -6.7 (HR 2.56, 95%-CI 0.18-37.17).
At ICU-admission, severely reduced BE appears superior to hyperlactatemia with regard to prediction of ICU-mortality in patients after cardiac surgery.