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The Journal of Cardiovascular Surgery 2021 August;62(4):391-8

DOI: 10.23736/S0021-9509.21.11538-1


lingua: Inglese

Bilirubin and lactate: easy to determine and valuable to predict outcome in cardiac surgery

Benjamin LUCHTING 1, 2, Lorenz MIHATSCH 3, Anastasiia HOLOVCHAK 3, Ruben WIßKOTT 3, Alexey DASHKEVICH 4, Isabel KIESEWETTER 1, Erich KILGER 1, Jens HEYN 1

1 Department of Anesthesiology, University of Munich (LMU), Munich, Germany; 2 Unit of Interdisciplinary Pain Center, Klinikum Landsberg am Lech, Landsberg am Lech, Germany; 3 Unit of Statistical Consulting StaBLab, Department of Statistics, University of Munich (LMU), Munich, Germany; 4 Department of Cardiac Surgery, University of Munich (LMU), Munich, Germany

BACKGROUND: Cardiopulmonary bypass during cardiac surgery is associated with metabolic changes after operation and results inter alia in increased levels of lactate and bilirubin. Since prediction of the course after operation has become very important for the management of an ICU and the patients themselves, we evaluated easily assessable markers (lactate and bilirubin), regarding their potential to predict mortality 90 days after surgery and the length of stay in ICU.
METHODS: All patients within a period of five years undergoing cardiac surgery were enrolled in the study. Among others peak levels of lactate and bilirubin within 48 hours after operation were recorded. A Cox proportional hazard model as well as a logistic regression model were used to predict mortality or rather length of stay in ICU.
RESULTS: Increased levels of bilirubin and lactate were associated with a significantly increase in mortality and length of stay in ICU (in a concentration-related manner). Interestingly, creatinine serum levels before operation showed a similar performance.
CONCLUSIONS: Three easily assessable and cheap laboratory parameters (bilirubin, lactate, and creatinine) are useful to predict 90-day mortality and length of stay in ICU. These findings might be helpful to give patients a reliable prediction about short and mid-term-survival and to improve the management of an ICU.

KEY WORDS: Lactates; Cardiac surgical procedures; Cardiopulmonary bypass

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