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Relationship between intraoperative serum lactate and hemoglobin levels on postoperative renal function in patients undergoing elective cardiac surgery
Author(s) -
Mitchell Steven C.,
Vinnakota Anirudh,
Deo Salil V.,
Markowitz Alan H.,
Sareyyupoglu Basar,
Elgudin Yakov,
Medalion Benjamin,
Tzagournis Adam,
Sabik Joseph,
Park Soon J.
Publication year - 2018
Publication title -
journal of cardiac surgery
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.428
H-Index - 58
eISSN - 1540-8191
pISSN - 0886-0440
DOI - 10.1111/jocs.13713
Subject(s) - medicine , acute kidney injury , renal function , hemoglobin , creatinine , cardiopulmonary bypass , odds ratio , cardiac surgery , surgery , cardiology , urology , gastroenterology , anesthesia
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.