Frequency of blood lactate elevation following esophagectomy and its association to postoperative complications

Early Postoperative Serum Lactate Levels Predict Anastomotic Leakage After Minimally Invasive Esophagectomy

BACKGROUND

Anastomotic leakage (AL) is a major complication after esophagectomy for esophageal cancer, and the significance of elevated postoperative lactate levels in the occurrence of AL is unclear.

PATIENTS AND METHODS

We evaluated 583 patients who underwent minimally invasive esophagectomy for esophageal cancer. Serum lactate levels were measured immediately after esophagectomy and in the morning on postoperative days (POD) 1, 2, 3, and 4. We also evaluated the factors associated with AL using multivariable logistic regression analysis.

RESULTS

AL occurred in 8.9% (n = 52) of patients, and the median onset of AL was POD10 (interquartile range: 7-13). The lactate levels immediately after esophagectomy through POD3 were significantly higher in patients with AL than in those without AL. A further multivariable logistic regression analysis showed that elevated lactate level on POD2 was an independent predictor of the occurrence of AL (odds ratio 11.9; 95% confidence interval: 4.04-17.3; P < 0.001). Severe AL was significantly more frequent in the higher lactate patients (P < 0.001). Furthermore, in patients with AL with higher lactate, the onset tended to be earlier (P = 0.054), and the treatment duration of AL was significantly longer compared with those with lower lactate (P = 0.037).

CONCLUSIONS

AL was significantly associated with elevated postoperative lactate levels. Elevated lactate levels on POD2 could be significant predictor of AL development after esophagectomy.

Serum Lactate Is an Indicator for Short-Term and Long-Term Mortality in Patients with Acute Pancreatitis

BACKGROUND

Serum lactate, as a single and an easily available biomarker, has been applied in various diseases.

AIMS

In this study, we aimed to explore the predictive value of serum lactate for short-term and long-term prognosis in acute pancreatitis (AP) admitted in intensive care unit (ICU) based on a large-scale database.

METHODS

AP patients admitted in ICU in the MIMIC-IV database were included. We constructed three different models to investigate the relationships between serum lactate and clinical outcomes, including 30-day, 180-day and 1-year mortality in AP. Smooth fitting curves were performed for intuitively demonstrating the relationship between serum lactate and different outcomes in AP by the generalized additive model.

RESULTS

A total of 895 AP patients admitted in ICU were included. The mortalities of 30 days, 180 days, and 1 year were 12.63% (n = 113), 16.87% (n = 151), and 17.54% (n = 157). In model B, with 1-mmol/L increment in serum lactate, the values of OR in 30-day, 180-day and 1-year mortality were 1.20 (95%CI 1.04-1.37, P = 0.0094), 1.21 (95%CI 1.06-1.37, P = 0.0039), and 1.21 (95%CI 1.07-1.38, P = 0.0035). The AUCs of serum lactate for predicting 30-day, 180-day, and 1-year mortality in AP were 0.688 (95%CI 0.633-0.743), 0.655 (95%CI 0.605-0.705), and 0.653 (95%CI 0.603-0.701), respectively. The cut-off value of serum lactate predicting 30-day, 180-day and 1-year mortality in AP was 2.4 mmol/L.

CONCLUSION

Serum lactate could be an indicator for short-term and long-term mortality in patients with AP admitted in ICU.