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Serum lactate and base deficit as predictors of mortality after ruptured abdominal aortic aneurysm repair.

Singhal, Rishi and Coghill, J E and Guy, A and Bradbury, A W and Adam, D J and Scriven, J M (2005) Serum lactate and base deficit as predictors of mortality after ruptured abdominal aortic aneurysm repair. European journal of vascular and endovascular surgery : the official journal of the European Society for Vascular Surgery, 30 (3). pp. 263-6. ISSN 1078-5884. This article is accessible to all HEFT staff and students via NHS Evidence www.evidence.nhs.uk by using their HEFT Athens login IDs

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Official URL: http://www.ejves.com/article/S1078-5884(05)00187-5...

Abstract

OBJECTIVE

Whole body hypoperfusion and lower torso ischaemia-reperfusion contribute to post-operative organ dysfunction in patients undergoing repair of ruptured abdominal aortic aneurysm (AAA). Serum lactate and base deficit are markers of tissue ischaemia and are used to assess the adequacy of resuscitation. This study examines the prognostic value of immediate post-operative levels of serum lactate and base deficit in ruptured AAA.

METHODS

Thirty patients (24 men and 6 women of median age 74, range 51-85, years) who survived to at least 12h after ruptured AAA repair were studied retrospectively. The relationship between immediate post-operative lactate, base deficit and mortality was determined.

RESULTS

Fifteen patients (50%) died, all from organ failure. An elevated lactate (>2.1 mmol/l) and base deficit (<-2 mmol/l) were present in 20 (67%) and 27 (90%) patients, respectively. Lactate (p<0.001) and base deficit (p=0.003) were significantly higher in non-survivors compared with survivors. Lactate (p=0.021) and base deficit levels (p=0.028) were independently significant for predicting mortality and a significant interaction existed between lactate and base deficit levels for predicting mortality (p=0.027). The sensitivity and specificity of lactate > or =4.0 mmol/l was 13 of 15 (87%) and 12 of 15 (80%), respectively, and base deficit < or =-7 mmol/l was 12 of 15 (80%) and 12 of 15 (80%), respectively. The likelihood ratios for a positive result with the defined cut-off values for lactate and base deficit were 4.3 and 4.0, respectively. Lactate > or =4.0 mmol/l and base deficit <or =-7 mmol/l were associated with a 94.5% probability of death while lactate < or =4.0 mmol/l and base deficit > or =-7 mmol/l were associated with a 4% probability of death.

CONCLUSION

These data demonstrate that an immediate post-operative serum lactate > or =4.0 mmol/l and base deficit < or =-7 mmol/l are good predictors of outcome after ruptured AAA repair. The prognostic value of these simple and inexpensive tests require corroboration in a larger prospective study.

Item Type: Article
Additional Information: This article is accessible to all HEFT staff and students via NHS Evidence www.evidence.nhs.uk by using their HEFT Athens login IDs
Subjects: WG Cardiovascular system. Cardiology
WO Surgery
Divisions: Planned IP Care > Vascular
Related URLs:
Depositing User: Sophie Rollason
Date Deposited: 12 Jun 2014 15:32
Last Modified: 12 Jun 2014 15:32
URI: http://www.repository.heartofengland.nhs.uk/id/eprint/249

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