Lactate Non-Clearance versus Lactate Clearance: A Comparison of Hospital Mortality in High-Risk Surgical Patients
Thammasak Thawitsri MD*1, Somkid Thongdee RN*2, Nalin Chokengarmwong MD*1, Manasnun Kongwibulwut MD*1, Kanya Kumwilaisak MD*1, Sahadol Poonyathawon MD*1, Pornlert Chatkaew MD*1, Somrat Charuluxananan MD*1
Affiliation : *1 Department of Anesthesiology, Faculty of Medicine, Chulalongkorn University, King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand *2 Division of Nursing, King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand
Objective : The optimal endpoints of resuscitation in high-risk surgical patients remain controversial. Specifically, it is difficult
to establish the effective predictive markers as the endpoints of resuscitation in this patient group. Therefore, the study was
conducted to assess the predictive value of early lactate non-clearance condition on hospital mortality in high-risk surgical
patients.
Material and Method: The study is a prospective analytic study. The data were collected in one university-based surgical
intensive care unit (SICU) over a 5-month period. All consecutive adult high-risk surgical patients admitted to SICU in
postoperative period were recruited to the study. Blood lactate levels were measured on SICU admission (0-hour), 12 hours
later, and then calculated for 12-hour blood lactate clearance. The authors categorized the patients into two groups: lactate
clearance (LC) and lactate non-clearance (LNC). After that, the patients were monitored until hospital discharge or in-
hospital death.
Results : There were 122 high-risk surgical patients recruited to the study. As concerns the factors of interest, higher
incidences of suspected or confirmed infection and mechanical ventilation were found among the LNC group. Regarding the
main outcomes, hospital mortality was 5.3% among the LNC group and 3.9% among the LC group (p = 0.578), with no
statistical significant differences in hospital mortality, hospital length of stay and SICU length of stay. The independent risk
factors associated with LNC condition were considered. The factor of interest was suspected or confirmed infection by
multiple logistic regression analysis after adjustment for age and sex revealed that the adjusted odds ratio was 2.70 with a
95% confidence interval of 0.85-8.55, p = 0.092.
Conclusion : In high-risk surgical patients, 12-hour LNC cannot demonstrate the prognostic value for hospital morbidity
and mortality. However, there is a trend for the suspected or confirmed infection group to associate with the LNC condition,
but with no statistical significance.
Keywords : Lactate clearance, High-risk surgical patients, Resuscitation, SICU
