Several studies linked postoperative hyperlactatemia to worse outcomes in adult patients undergoing cardiac surgery. However, data on the effect of timing of hyperlactatemia on outcomes are scarce. We sought to determine the prevalence of early hyperlactatemia (EHL) and its impact on clinical outcomes compared to late hyperlactatemia (LHL) in patients undergoing ACS procedures. We included 305 consecutive adult patients who underwent cardiac surgery procedures between July 2017 and Nov 2019 at a single institution. Lactate level was measured in the first 10 h after surgery and EHL was defined as lactate level > 3 mmol/L in the first hour after surgery. Logistic regression analysis was performed to determine predictors of EHL. Seventeen percent (n = 52) had EH while 83% (n = 253) did not. Patients with EHL had significantly longer cardiopulmonary bypass (P = 0.001) and cross-clamp (P = 0.001) times due to increased surgical complexity in this group. Early hyperlactatemia was associated with increased post-operative extracorporeal membrane oxygenation (ECMO) support (0% vs 5.7%, P < 0.001), longer intensive care unit stay (P = 0.004), and increased hospital mortality (0% vs. 3.8%, P = 0.009). Cardiopulmonary bypass time (OR 1.001; 95% CI 1.011–1.012, P = 0.02) and glucose level (OR 1.2; 95% CI 1.1–1.3, P = 0.003) were independently associated with increased rate of EHL. In contrast, diabetes mellitus (OR 0.26; 95% CI 0.12–0.55, P < 0.001) significantly attenuated the rate of EHL. Early hyperlactatemia after cardiac surgery was associated with increased morbidity and mortality. Late hyperlactatemia was very common and had a self-limiting and benign course.

中文翻译：

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高脂血症时机对心脏手术结局的影响

几项研究将术后高乳酸血症与接受心脏手术的成年患者的不良结局联系起来。然而，关于高乳酸血症时间对预后的影响的数据很少。我们试图确定早期高脂血症（EHL）的患病率及其与ACS手术晚期高脂血症（LHL）相比对临床结局的影响。我们纳入了2017年7月至2019年11月在同一机构接受心脏外科手术的305名连续成年患者。在手术后的前10小时测量乳酸水平，将EHL定义为手术后第一小时的乳酸水平> 3 mmol / L。进行逻辑回归分析以确定EHL的预测因子。17％（n = 52）患有EH，而83％（n = 253）没有。由于该组手术复杂性增加，EHL患者的体外循环时间（P = 0.001）和交叉钳位（P = 0.001）明显更长。早期高乳酸血症与术后体外膜氧合（ECMO）支持增加（0％比5.7％，P <0.001），重症监护病房住院时间更长（P = 0.004）和医院死亡率增加（0％比3.8％）相关。 ，P = 0.009）。心肺旁路时间（OR 1.001； 95％CI 1.011–1.012，P = 0.02）和血糖水平（OR 1.2； 95％CI 1.1–1.3，P = 0.003）与EHL发生率独立相关。相反，糖尿病（OR 0.26； 95％CI 0.12-0.55，P <0.001）显着降低了EHL的发生率。心脏手术后的早期高脂血症与发病率和死亡率增加相关。