Aaron J. Lindsay, MD, Meng Xu, MS, Daniel I. Sessler, MD, Eugene H

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Presentation transcript:

Lactate Clearance Time and Concentration Linked to Morbidity and Death in Cardiac Surgical Patients Aaron J. Lindsay, MD, Meng Xu, MS, Daniel I. Sessler, MD, Eugene H. Blackstone, MD, C. Allen Bashour, MD The Annals of Thoracic Surgery Volume 95, Issue 2, Pages 486-492 (February 2013) DOI: 10.1016/j.athoracsur.2012.07.020 Copyright © 2013 The Society of Thoracic Surgeons Terms and Conditions

Fig 1 (A) Average time course of lactate clearance (solid line) in our patient population during the first 12 hours after cardiac operation. Confidence intervals (dashed lines) are included. The open circles represent average lactate measurements at that interval. Lactate measures are in mmol/L and time is measured in hours. (B) Average time course of lactate clearance in survivors (black line with overlying boxes) and nonsurvivors (solid gray line). Confidence intervals (dashed lines) are included. The open circles represent average lactate measurements at that time interval. The Annals of Thoracic Surgery 2013 95, 486-492DOI: (10.1016/j.athoracsur.2012.07.020) Copyright © 2013 The Society of Thoracic Surgeons Terms and Conditions

Fig 2 Frequency of plasma lactate concentration determinations during the initial 12 postoperative hours. The y axis represents the percentage of the population and the numbers above the bars represent the number of patients in each category. (total = 1,503 which is the true distribution of lactate measurements in all patients before excluding 212 patients who had missing data). The Annals of Thoracic Surgery 2013 95, 486-492DOI: (10.1016/j.athoracsur.2012.07.020) Copyright © 2013 The Society of Thoracic Surgeons Terms and Conditions

Fig 3 Frequency of adverse outcomes is shown in a sample size of 1,291 patients. Any type of reoperation was not included in the composite set after initial analysis showed its frequency was much higher than the other measured outcomes because it would influence the composite measure significantly more than the other measured outcomes. Death was defined as in-hospital death. Numbers above the bars represent the incidence of each outcome. The Annals of Thoracic Surgery 2013 95, 486-492DOI: (10.1016/j.athoracsur.2012.07.020) Copyright © 2013 The Society of Thoracic Surgeons Terms and Conditions

Fig 4 Combined receiver operating characteristic curve (ROC) plot is shown for predicting death from lactate clearance time (C statistic, 0.72; dashed line), from mean lactate concentration (C statistic, 0.77; dotted line), and from product value (C statistic, 0.82; bold, solid line). The standard error (SE) is shown. The Annals of Thoracic Surgery 2013 95, 486-492DOI: (10.1016/j.athoracsur.2012.07.020) Copyright © 2013 The Society of Thoracic Surgeons Terms and Conditions