Lactate as a Preoperative Predictor of Mortality in Patients Undergoing Emergency Type A Aortic Dissection Repair.

IF 3 3区 医学 Q2 HEALTH CARE SCIENCES & SERVICES
Sombuddha Bhadra, Rachel H Drgastin, Howard K Song, Frederick A Tibayan, Gurion Lantz, Julie W Doberne, Castigliano M Bhamidipati
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引用次数: 0

Abstract

Background: Aortic dissection is a life-threatening condition where emergent surgical repair is the standard of care. However, despite operative intervention, mortality is 10-15% in all patients. Objective markers to distinguish when surgical repair is more beneficial versus being futile are warranted. Currently, no such known measures are widely agreed upon. Since most complications from aortic dissection stem from malperfusion, serum lactate is thought to be a surrogate marker for malperfusion. This scoping review aims to examine the preoperative predictive value of lactate or lactate dehydrogenase (LDH) in assessing postoperative mortality in patients undergoing surgical repair for acute Stanford Type A aortic dissection (ATAAD). Methods: PubMed was searched for the following search terms: "Dissection, Ascending Aorta", "Dissection, Thoracic Aorta", or "Aortic Dissection". Prospective and retrospective randomized controlled trials, case reports, and cohort studies were included in the initial search. Studies were first screened for inclusion of preoperative lactate or LDH level with a search of "lac" or "LDH". Included studies consisted of patients aged 18 or older diagnosed with Stanford Type A/Debakey Type I and II aortic dissection with reported preoperative lactate or LDH levels and postoperative mortality treated within 14 days of symptom onset. Preoperative laboratory values were measured from samples collected prior to patient transfer to the operating room or before utilization of ECMO intraoperatively. Results: A comprehensive database search identified a total of 4722 articles. After a rigid screening process, 46 studies fit the inclusion criteria. These papers reported a combined 4696 participants with either preoperative lactate or LDH levels and postoperative mortality. The mean preoperative lactate level was 2.4 mmol/L, whereas the LDH level was 424.9 U/L. Postoperative mortality was 16.51%. Average creatinine, BUN, platelets, INR, PT, PTT, and hemoglobin were all within normal lab analysis limits. Conclusions: Neither lactate nor LDH should be used as a solo predictor of postoperative mortality after ATAAD due to lack of consensus on the cut-off values. Accompanying clinical signs, lab abnormalities, and radiographic findings taken together may be better predictors of prognosis.

乳酸作为紧急a型主动脉夹层修复患者术前死亡率的预测因子
背景:主动脉夹层是一种危及生命的疾病,紧急手术修复是治疗的标准。然而,尽管手术干预,所有患者的死亡率为10-15%。客观标记区分手术修复是有益的还是无效的是有必要的。目前,没有这种已知的措施得到广泛同意。由于主动脉夹层的大多数并发症源于灌注不良,血清乳酸被认为是灌注不良的替代标志物。本综述旨在探讨乳酸或乳酸脱氢酶(LDH)在评估急性Stanford A型主动脉夹层(ATAAD)手术修复患者术后死亡率中的术前预测价值。方法:在PubMed检索以下检索词:“夹层,升主动脉”、“夹层,胸主动脉”或“主动脉夹层”。最初的研究包括前瞻性和回顾性随机对照试验、病例报告和队列研究。首先通过搜索“lac”或“LDH”筛选纳入术前乳酸或LDH水平的研究。纳入的研究包括年龄在18岁或以上,诊断为Stanford A型/Debakey I型和II型主动脉夹层的患者,报告术前乳酸或乳酸脱氢酶水平,并在症状出现后14天内治疗术后死亡率。术前实验室值从患者转移到手术室之前或术中使用ECMO之前收集的样本中测量。结果:综合数据库检索共鉴定出4722篇文章。经过严格的筛选,46项研究符合纳入标准。这些论文共报道了4696名术前乳酸或乳酸脱氢酶水平和术后死亡率的参与者。术前平均乳酸水平为2.4 mmol/L, LDH水平为424.9 U/L。术后死亡率为16.51%。平均肌酐、BUN、血小板、INR、PT、PTT和血红蛋白均在正常的实验室分析范围内。结论:乳酸和乳酸脱氢酶都不应该作为ATAAD术后死亡率的单独预测指标,因为对临界值缺乏共识。伴随的临床症状、实验室异常和x线检查结果可能是更好的预后预测指标。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
Journal of Personalized Medicine
Journal of Personalized Medicine Medicine-Medicine (miscellaneous)
CiteScore
4.10
自引率
0.00%
发文量
1878
审稿时长
11 weeks
期刊介绍: Journal of Personalized Medicine (JPM; ISSN 2075-4426) is an international, open access journal aimed at bringing all aspects of personalized medicine to one platform. JPM publishes cutting edge, innovative preclinical and translational scientific research and technologies related to personalized medicine (e.g., pharmacogenomics/proteomics, systems biology). JPM recognizes that personalized medicine—the assessment of genetic, environmental and host factors that cause variability of individuals—is a challenging, transdisciplinary topic that requires discussions from a range of experts. For a comprehensive perspective of personalized medicine, JPM aims to integrate expertise from the molecular and translational sciences, therapeutics and diagnostics, as well as discussions of regulatory, social, ethical and policy aspects. We provide a forum to bring together academic and clinical researchers, biotechnology, diagnostic and pharmaceutical companies, health professionals, regulatory and ethical experts, and government and regulatory authorities.
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