Universität zu Köln

Badreldin, Akmal M. A., Doerr, Fabian, Brehm, Bernhard R., Abul-dahab, Mohamed, Lehmann, Thomas, Bayer, Ole, Wahlers, Thorsten and Hekmat, Khosro (2013). Mortality Prediction after Cardiac Surgery: Blood Lactate Is Indispensible. Thorac. Cardiovasc. Surg., 61 (8). S. 708 - 718. STUTTGART: GEORG THIEME VERLAG KG. ISSN 1439-1902

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Abstract

BackgroundBlood lactate is accepted as a mortality risk marker in intensive care units (ICUs), especially after cardiac surgery. Unfortunately, most of the commonly used ICU risk stratification scoring systems did not include blood lactate as a variable. We hypothesized that blood lactate alone can predict the risk of mortality after cardiac surgery with an accuracy that is comparable to those of other complex models. We therefore evaluated its accuracy at mortality prediction and compared it with that of other widely used complex scoring models statistically. MethodsWe prospectively collected data of all consecutive adult patients who underwent cardiac surgery between January 1, 2007, and December 31, 2009. By using (2) statistics, a blood lactate-based scale (LacScale) with only four cutoff points was constructed in a developmental set of patients (January 1, 2007, and May 31, 2008). LacScale included five categories: 0 ( 1.7 mmol/L); 1 (1.8-5.9 mmol/L), 2 (6.0-9.3 mmol/L), 3 (9.4-13.3 mmol/L), and 4 ( 13.4 mmol/L). Its accuracy at predicting ICU mortality was evaluated in another independent subset of patients (validation set, June 1, 2008, and December 31, 2009) on both study-population level (calibration analysis, overall correct classification) and individual-patient-risk level (discrimination analysis, ROC statistics). The results were then compared with those obtained from other widely used postoperative models in cardiac surgical ICUs (Sequential Organ Failure Assessment [SOFA] score, Simplified Acute Physiology Score II [SAPS II], and Acute Physiology and Chronic Health Evaluation II [APACHE II] score). ResultsICU mortality was 5.8% in 4,054 patients. LacScale had a reliable calibration in the validation set (2,087 patients). It was highly accurate in predicting ICU mortality with an area under the ROC curve (area under curve [AUC]; discrimination) of 0.88. This AUC was significantly larger than that of all the other models (SOFA 0.83, SAPS II: 0.79 and APACHE II: 0.76) according to DeLong's comparison. Integrating the LacScale in those scores further improved their accuracy by increasing their AUCs (0.88, 0.81, and 0.80, respectively). This improvement was also highly significant. ConclusionBlood lactate accurately predicts mortality at both individual patient risk and patient cohort levels. Its precision is higher than that of other commonly used complex scoring models. The proposed LacScale is a simple and highly reliable model. It can be used (at bedside without electronic calculation) as such or integrated in other models to increase their accuracy.

Item Type:	Journal Article
Creators:	Creators Email ORCID ORCID Put Code Badreldin, Akmal M. A. UNSPECIFIED UNSPECIFIED UNSPECIFIED Doerr, Fabian UNSPECIFIED UNSPECIFIED UNSPECIFIED Brehm, Bernhard R. UNSPECIFIED UNSPECIFIED UNSPECIFIED Abul-dahab, Mohamed UNSPECIFIED UNSPECIFIED UNSPECIFIED Lehmann, Thomas UNSPECIFIED UNSPECIFIED UNSPECIFIED Bayer, Ole UNSPECIFIED UNSPECIFIED UNSPECIFIED Wahlers, Thorsten UNSPECIFIED UNSPECIFIED UNSPECIFIED Hekmat, Khosro UNSPECIFIED UNSPECIFIED UNSPECIFIED
URN:	urn:nbn:de:hbz:38-470863
DOI:	10.1055/s-0032-1324796
Journal or Publication Title:	Thorac. Cardiovasc. Surg.
Volume:	61
Number:	8
Page Range:	S. 708 - 718
Date:	2013
Publisher:	GEORG THIEME VERLAG KG
Place of Publication:	STUTTGART
ISSN:	1439-1902
Language:	English
Faculty:	Unspecified
Divisions:	Unspecified
Subjects:	no entry
Uncontrolled Keywords:	Keywords Language CRITICALLY-ILL PATIENTS; GOAL-DIRECTED THERAPY; CARDIOPULMONARY BYPASS; HOSPITAL MORTALITY; RISK; HYPERLACTATEMIA; VALIDATION; EUROSCORE; CHILDREN; FAILURE Multiple languages Cardiac & Cardiovascular Systems; Respiratory System; Surgery Multiple languages
URI:	http://kups.ub.uni-koeln.de/id/eprint/47086