Xinyi Li, Xiaodan Dong, Jianhua Luo, Lin Wang, Yang Cao, Yan Zhang, Bing Liang
{"title":"Perioperative lactate levels as prognostic indicators in patients undergoing early excision and grafting for extensive burns.","authors":"Xinyi Li, Xiaodan Dong, Jianhua Luo, Lin Wang, Yang Cao, Yan Zhang, Bing Liang","doi":"10.1186/s12893-025-03133-y","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Elevated lactate levels are reliable biomarkers of tissue hypoperfusion and metabolic stress. However, their prognostic significance in extensive burn patients undergoing early excision and grafting (EEG) remains unclear. This study aimed to evaluate the prognostic value of perioperative lactate levels in predicting clinical deterioration following EEG in patients with extensive burns.</p><p><strong>Methods: </strong>In this retrospective cohort study, adult burn patients with ≥ 50% total burn surface area (TBSA) or ≥ 20% full-thickness burns treated between March 2021 and September 2023 were included. Patients were categorized into Deterioration and Non-Deterioration groups based on changes in Sequential Organ Failure Assessment (SOFA) scores. Statistical analyses included univariate and multivariate logistic regression, as well as receiver-operating characteristic (ROC) curve analysis.</p><p><strong>Results: </strong>Of 82 patients, 37.8% were classified into the Deterioration Group. Compared with the Non-Deterioration Group, these patients presented with a significantly higher burn index (BI), larger surgical area, and greater intraoperative blood transfusion volumes. Temporal trends in lactate levels appeared to differ between groups: lactate levels peaked on POD1 and returned to baseline by postoperative Day 3(POD3) in the Non-Deterioration Group, whereas they remained persistently elevated in the Deterioration Group. Among all perioperative time points, lactate levels on POD3 were significantly higher in the Deterioration Group (2.88 ± 0.65 mmol/L vs. 2.27 ± 0.68 mmol/L, p < 0.001) and were independently associated with clinical deterioration clinical deterioration (OR 2.97, 95% CI 1.18-8.71, p = 0.031). POD3 lactate levels demonstrated the highest discriminatory performance for identifying postoperative deterioration (AUC = 0.761, 95% CI 0.656-0.866).</p><p><strong>Conclusions: </strong>Among perioperative lactate levels in patients undergoing EEG for extensive burns, POD3 lactate levels were significantly associated with clinical deterioration and may serve as a useful marker to guide early risk assessment and supportive interventions.</p>","PeriodicalId":49229,"journal":{"name":"BMC Surgery","volume":"25 1","pages":"402"},"PeriodicalIF":1.8000,"publicationDate":"2025-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12398966/pdf/","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"BMC Surgery","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1186/s12893-025-03133-y","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"SURGERY","Score":null,"Total":0}
引用次数: 0
Abstract
Background: Elevated lactate levels are reliable biomarkers of tissue hypoperfusion and metabolic stress. However, their prognostic significance in extensive burn patients undergoing early excision and grafting (EEG) remains unclear. This study aimed to evaluate the prognostic value of perioperative lactate levels in predicting clinical deterioration following EEG in patients with extensive burns.
Methods: In this retrospective cohort study, adult burn patients with ≥ 50% total burn surface area (TBSA) or ≥ 20% full-thickness burns treated between March 2021 and September 2023 were included. Patients were categorized into Deterioration and Non-Deterioration groups based on changes in Sequential Organ Failure Assessment (SOFA) scores. Statistical analyses included univariate and multivariate logistic regression, as well as receiver-operating characteristic (ROC) curve analysis.
Results: Of 82 patients, 37.8% were classified into the Deterioration Group. Compared with the Non-Deterioration Group, these patients presented with a significantly higher burn index (BI), larger surgical area, and greater intraoperative blood transfusion volumes. Temporal trends in lactate levels appeared to differ between groups: lactate levels peaked on POD1 and returned to baseline by postoperative Day 3(POD3) in the Non-Deterioration Group, whereas they remained persistently elevated in the Deterioration Group. Among all perioperative time points, lactate levels on POD3 were significantly higher in the Deterioration Group (2.88 ± 0.65 mmol/L vs. 2.27 ± 0.68 mmol/L, p < 0.001) and were independently associated with clinical deterioration clinical deterioration (OR 2.97, 95% CI 1.18-8.71, p = 0.031). POD3 lactate levels demonstrated the highest discriminatory performance for identifying postoperative deterioration (AUC = 0.761, 95% CI 0.656-0.866).
Conclusions: Among perioperative lactate levels in patients undergoing EEG for extensive burns, POD3 lactate levels were significantly associated with clinical deterioration and may serve as a useful marker to guide early risk assessment and supportive interventions.
背景：乳酸水平升高是组织灌注不足和代谢应激的可靠生物标志物。然而，它们在接受早期切除和移植（EEG）的大面积烧伤患者中的预后意义尚不清楚。本研究旨在评估围手术期乳酸水平在预测大面积烧伤患者脑电图后临床恶化中的预后价值。方法：在这项回顾性队列研究中，纳入了2021年3月至2023年9月期间治疗的总烧伤表面积(TBSA)≥50%或全层烧伤≥20%的成人烧伤患者。根据顺序器官衰竭评估（SOFA）评分的变化将患者分为恶化组和非恶化组。统计分析包括单因素和多因素logistic回归，以及受试者工作特征（ROC）曲线分析。结果：82例患者中，37.8%归为恶化组。与未恶化组相比，这些患者的烧伤指数（BI）明显更高，手术面积更大，术中输血量更大。两组间乳酸水平的时间趋势似乎有所不同：未恶化组乳酸水平在POD1达到峰值，并在术后第3天（POD3）恢复到基线水平，而恶化组乳酸水平持续升高。在所有围手术期时间点中，恶化组的乳酸水平显著高于对照组（2.88±0.65 mmol/L vs. 2.27±0.68 mmol/L）。结论：在大面积烧伤行脑电图患者围手术期乳酸水平中，乳酸水平与临床恶化显著相关，可作为指导早期风险评估和支持干预的有用指标。
求助内容：
应助结果提醒方式：
京公网安备 11010802042870号
