Relationship between intraoperative serum lactate and hemoglobin levels on postoperative renal function in patients undergoing elective cardiac surgery. Issue 6 (3rd May 2018)

• Record Type: Journal Article
• Authors: Mitchell, Steven C.; Vinnakota, Anirudh; Deo, Salil V.; Markowitz, Alan H.; Sareyyupoglu, Basar; Elgudin, Yakov; Medalion, Benjamin; Tzagournis, Adam; Sabik, Joseph; Park, Soon J.
• Is Part Of: Journal of cardiac surgery. Volume 33:Issue 6(2018)
• Page Start: 316
• Page End: 321
• Publication Date: 2018-05-03
• Subjects: AKI -- CABG -- hemoglobin -- lactate; Heart -- Surgery -- Periodicals; 617.412005
• DOI: 10.1111/jocs.13713
• Languages: English
• ISSNs: 0886-0440

Abstract

Abstract: Background and Aim: We examined the relationship between serum lactate and hemoglobin levels on renal function and postoperative outcome in low‐risk elective coronary artery bypass graft (CABG) patients. Methods: Intraoperative hemoglobin and lactate levels were measured in elective isolated CABG patients. Patients with renal dysfunction (baseline creatinine>2 mg/dL) were excluded. Multivariate logistic regression was used to determine associations between lactate, hemoglobin, and acute kidney injury (AKI). Results: A total of 375 patients met study requirements, and 56/375 (15%) developed AKI. Of the patients who developed AKI, 43/278 (15.5%) were males, 13/97 (13.4%) females, and 11/44 (25%) African‐Americans. Bivariate analysis between AKI and non‐AKI subgroups found significant differences in age, race, baseline estimated glomerular filtration rate, preoperative hemoglobin, peak serum lactate, initial hemoglobin, and nadir hemoglobin. A high peak Lactate level (odds ratio [OR] 1.44[1.15‐1.82]), low hemoglobin (OR 0.69[0.49‐0.96]), and African American race (OR 2.26[0.96‐5.05]) were independently associated with acute kidney injury. A significant relationship between decreasing intraoperative hemoglobin and increasing intraoperative serum lactate levels was observed exclusively in patients who developed postoperative AKI. Serum creatinine levels peaked, on average, 48 h postoperatively in the AKI subset of patients. Conclusion: In this series, 15% of patients who underwent elective cardiopulmonary bypass developed transient acute renal dysfunction. High lactate levels and low hemoglobin levels during cardiopulmonary bypass were associated with an increased risk of kidney injury.