Hyperlactatemia may be caused by increased production due to tissue hypoxia or non-hypoxia. The aim of this study was first to identify risk factors for postoperative hyperlactatemia (POHL) after Stanford type A acute aortic dissection surgery (AADS) and construct a predictive model, and second to evaluate the impact of POHL on prognosis. This retrospective study involved patients undergoing AADS from January 2016 to December 2019 in Wuhan Union Hospital. Multivariate logistic regression analysis was performed to identify independent risk factors for POHL. A nomogram predicting POHL was established based on these factors and was validated in the original dataset. The receiver operating characteristic curve was drawn to assess the ability of postoperative lactate levels to predict the in-hospital mortality. A total of 188 patients developed POHL after AADS (38.6%). Male gender, surgery history, red blood cell transfusion and cardiopulmonary bypass time were identified as independent predictors. The C-index of the prediction model for POHL was 0.72, indicating reasonable discrimination. The model was well calibrated by visual inspection and goodness-of-fit test (Hosmer–Lemeshow χ2 = 10.25, P = 0.25). Decision and clinical impact curves of the model showed good clinical utility. The overall in-hospital mortality rate was 10.1%. Postoperative lactate levels showed a moderate predictive power for postoperative in-hospital mortality (C-index: 0.72). We developed and validated a prediction model for POHL in patients undergoing AADS, which may have clinical utility in personal risk evaluation and preventive interventions. The POHL could be a good predictor for in-hospital mortality.

中文翻译：

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急性A型主动脉夹层术后患者术后高乳酸血症的危险因素及院内死亡率

高乳酸血症可能是由于组织缺氧或非缺氧导致的产量增加引起的。本研究的目的首先是确定斯坦福 A 型急性主动脉夹层手术（AADS）术后高乳酸血症（POHL）的危险因素并构建预测模型，其次是评估 POHL 对预后的影响。这项回顾性研究涉及 2016 年 1 月至 2019 年 12 月在武汉协和医院接受 AADS 的患者。进行多变量逻辑回归分析以确定 POHL 的独立危险因素。基于这些因素建立了预测 POHL 的列线图，并在原始数据集中进行了验证。绘制受试者工作特征曲线以评估术后乳酸水平预测住院死亡率的能力。共有 188 名患者在 AADS 后发展为 POHL（38.6%）。男性、手术史、红细胞输注和体外循环时间被确定为独立预测因素。POHL 预测模型的 C 指数为 0.72，表明区分度合理。该模型通过目视检查和拟合优度检验得到了很好的校准（Hosmer-Lemeshow χ2 = 10.25，P = 0.25）。该模型的决策和临床影响曲线显示出良好的临床效用。总体住院死亡率为10.1%。术后乳酸水平对术后住院死亡率显示出中等的预测能力（C 指数：0.72）。我们开发并验证了接受 AADS 患者的 POHL 预测模型，该模型可能在个人风险评估和预防干预方面具有临床实用性。