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

Zante, Björn; Reichenspurner, Hermann; Kubik, Mathias; Kluge, Stefan; Schefold, Joerg C.; Pfortmüller, Carmen (2018). Base excess is superior to lactate-levels in prediction of ICU mortality after cardiac surgery. PLoS ONE, 13(10), e0205309. Public Library of Science 10.1371/journal.pone.0205309

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INTRODUCTION 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. MATERIALS AND METHODS 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. RESULTS 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). CONCLUSIONS At ICU-admission, severely reduced BE appears superior to hyperlactatemia with regard to prediction of ICU-mortality in patients after cardiac surgery.

Item Type:

Journal Article (Original Article)

Division/Institute:

04 Faculty of Medicine > Department of Intensive Care, Emergency Medicine and Anaesthesiology (DINA) > Clinic of Intensive Care

UniBE Contributor:

Zante, Björn; Schefold, Joerg C. and Pfortmüller, Carmen

Subjects:

600 Technology > 610 Medicine & health

ISSN:

1932-6203

Publisher:

Public Library of Science

Language:

English

Submitter:

Mirella Aeberhard

Date Deposited:

08 Oct 2018 16:31

Last Modified:

23 Oct 2019 23:36

Publisher DOI:

10.1371/journal.pone.0205309

PubMed ID:

30289956

BORIS DOI:

10.7892/boris.120365

URI:

https://boris.unibe.ch/id/eprint/120365

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