Asociación entre la concentración de lactato preoperatorio y la mortalidad intrahospitalaria tras la cirugía de urgencia

Abstract

Introduction

Lactate is widely used as a marker of metabolic and circulatory stress, but its prognostic value in emergency surgical populations remains incompletely defined.

Methods

We conducted a retrospective cohort study using the INSPIRE dataset, including emergency surgical procedures with a preoperative lactate measurement within six hours before incision. The primary outcome was in-hospital mortality. Multivariable logistic regression adjusted for age, sex, ASA physical status, surgical department, anaesthesia type, preoperative haemoglobin and creatinine. Lactate was analysed using restricted cubic splines and in prespecified categories (<2, 2–< 4 and ≥4 mmol l^-1). Incremental prognostic value was assessed by comparing a baseline clinical model with and without lactate.

Results

The analytic cohort included 3729 emergency surgical procedures, of which 360 resulted in in-hospital death (9.7%). Mortality increased across lactate categories: 6.9% for lactate < 2 mmol l^-1, 13.9% for lactate 2–< 4 mmol l^-1 and 42.2% for lactate ≥4 mmol l^-1. After adjustment, lactate remained associated with mortality (odds ratio 1.79 [95% CI 1.23–2.59] for 2–< 4 mmol l^–1 and 7.34 [4.65–11.57] for ≥4 mmol l^-1 vs. < 2 mmol l^-1). Adding lactate to the standard clinical model improved discrimination (AUC 0.755 vs. 0.801) and reduced the Brier score (0.094 vs. 0.088). Results were consistent across alternative measurement windows and after multiple imputation.

Conclusion

Preoperative lactate concentration was strongly associated with in-hospital mortality and provided incremental prognostic information beyond routinely available variables. In emergency surgical pathways, lactate may support early risk stratification.