Association Between Serum Lactate and Unsatisfactory Outcomes in Critically Ill Children in the Immediate Post-operative Period of Liver Transplantation

Jaime Fernández-Sarmiento; María Angélica Wilches-Cuadros; Ricardo Hernandez-Sarmiento; Hernando Mulett; Karen Moreno-Medina; Nicolás Molano; Julián Augusto Palomar Dominguez; Lorena Acevedo; Claudia Salinas; Jairo Rivera

doi:10.3389/fped.2021.796504

Association Between Serum Lactate and Unsatisfactory Outcomes in Critically Ill Children in the Immediate Post-operative Period of Liver Transplantation

Título traducido de la contribución: Asociación entre el lactato sérico y los resultados insatisfactorios en niños gravemente enfermos en el postoperatorio inmediato del trasplante hepático

Jaime Fernández-Sarmiento
, María Angélica Wilches-Cuadros
, Ricardo Hernandez-Sarmiento
, Hernando Mulett
, Karen Moreno-Medina
, Nicolás Molano
, Julián Augusto Palomar Dominguez
, Lorena Acevedo
, Claudia Salinas
, Jairo Rivera

Producción científica: Contribución a revista › Artículo de Investigación › revisión exhaustiva

8 Citas (Scopus)

Resumen

Objetivos: El lactato sérico es un biomarcador útil de la perfusión tisular en pacientes críticos. Se evaluó el comportamiento del lactato sérico en niños ingresados en la unidad de cuidados intensivos pediátricos (UCIP) inmediatamente después del trasplante hepático y su asociación con las complicaciones quirúrgicas, la disfunción del injerto y la mortalidad a los 90 días. Materiales y métodos: Estudio observacional prospectivo realizado entre noviembre de 2009 y diciembre de 2019. UCIP multidisciplinaria del Hospital Infantil Universitario, Fundación Cardioinfantil-IC, Bogotá, Colombia. Mediciones y resultados principales: Se incluyeron pacientes entre 1 mes y 18 años de edad que se encontraban en el postoperatorio inmediato posterior a trasplante hepático de donante vivo o cadavérico. Un total de 145 pacientes con una mediana de edad de 14 meses (IQR 8-60) cumplieron los criterios de inclusión. La atresia biliar fue el diagnóstico principal en el 56,5% de los casos. Un nivel de lactato sérico > 3,0 mmol/L al ingreso en la UCIP se asoció con complicaciones biliares (AUC 0,73; IC del 95%: 0,54-0,93; p = 0,05) y mortalidad (AUC 0,72; IC del 95%: 0,63-0,8; p = 0,01). Un nivel de lactato > 2 mmol/L después de 6 h en la UCIP se asoció con la mortalidad (AUC 0,70; IC del 95%: 0,54-0,83; p = 0,02). Los niveles más altos de lactato y la falta de aclaramiento se asociaron con la presencia de formas de onda tardus et parvus (p = 0,001) en el Doppler hepático, disfunción primaria (p < 0,001), trombosis arterial (p < 0,001) y complicaciones neurológicas (p = 0,04). Hubo una correlación inversa entre el lactato al ingreso y el volumen de líquidos administrados durante la cirugía (rho = 0,36; p < 0,001). Un tiempo total de intervención > 350 min, junto con una puntuación de vasopresores > 7 y un lactato elevado, se asociaron a peores resultados (p < 0,001). Conclusiones: En pacientes pediátricos postoperados de trasplante hepático, el nivel de lactato sérico se asocia con complicaciones quirúrgicas postoperatorias y mortalidad.

Título traducido de la contribución	Asociación entre el lactato sérico y los resultados insatisfactorios en niños gravemente enfermos en el postoperatorio inmediato del trasplante hepático
Idioma original	Inglés estadounidense
Número de artículo	796504
Publicación	Frontiers in Pediatrics
Volumen	9
DOI	https://doi.org/10.3389/fped.2021.796504
Estado	Publicada - ene. 24 2022

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Este resultado contribuye a los siguientes Objetivos de Desarrollo Sostenible

ODS 3: Salud y bienestar

Áreas temáticas de ASJC Scopus

Pediatría, perinaltología y salud infantil

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Fernández-Sarmiento, J., Wilches-Cuadros, M. A., Hernandez-Sarmiento, R., Mulett, H., Moreno-Medina, K., Molano, N., Dominguez, J. A. P., Acevedo, L., Salinas, C., & Rivera, J. (2022). Association Between Serum Lactate and Unsatisfactory Outcomes in Critically Ill Children in the Immediate Post-operative Period of Liver Transplantation. Frontiers in Pediatrics, 9, Artículo 796504. https://doi.org/10.3389/fped.2021.796504

@article{59fc457a24854847903255835a6a67a9,

title = "Association Between Serum Lactate and Unsatisfactory Outcomes in Critically Ill Children in the Immediate Post-operative Period of Liver Transplantation",

abstract = "Objectives: Serum lactate is a useful biomarker of tissue perfusion in critically ill patients. We evaluated the behavior of serum lactate in children in the pediatric intensive care unit (PICU) immediately after liver transplantation and its association with surgical complications, graft dysfunction and 90-day mortality. Materials and Methods: A prospective observational study carried out between November 2009 and December 2019. Multidisciplinary PICU at the University Children's Hospital, Fundaci{\'o}n Cardioinfantil-IC, Bogot{\'a}, Colombia. Measurements and Main Results: Patients between 1 month and 18 years of age who were in the immediate post-operative period following living-donor or cadaveric liver transplantation were included. A total of 145 patients with a median age of 14 months (IQR 8–60) met the inclusion criteria. Biliary atresia was the main diagnosis in 56.5\% of the cases. A serum lactate level > 3.0 mmol/L on admission to the PICU was associated with biliary complications (AUC 0.73 95\% CI 0.54–0.93; p = 0.05) and mortality (AUC 0.72 95\% CI 0.63–0.8; p = 0.01). A lactate level > 2 mmol/L after 6 h in the PICU was associated with mortality (AUC 0.70 95\% CI 0.54–0.83; p = 0.02). Higher lactate levels and lack of clearance were associated with the presence of tardus et parvus waveforms (p = 0.001) on liver Doppler, primary dysfunction (p < 0.001), arterial thrombosis (p < 0.001) and neurological complications (p = 0.04). There was an inverse correlation between admission lactate and the volume of fluids administered during surgery (rho = 0.36; p < 0.001). A total procedure time > 350 min, along with a vasopressor score > 7 and elevated lactate, were associated with worse outcomes (p < 0.001). Conclusions: In post-operative pediatric liver transplant patients, the level of serum lactate is associated with post-operative surgical complications and mortality.",

author = "Jaime Fern{\'a}ndez-Sarmiento and Wilches-Cuadros, \{Mar{\'i}a Ang{\'e}lica\} and Ricardo Hernandez-Sarmiento and Hernando Mulett and Karen Moreno-Medina and Nicol{\'a}s Molano and Dominguez, \{Juli{\'a}n Augusto Palomar\} and Lorena Acevedo and Claudia Salinas and Jairo Rivera",

note = "Publisher Copyright: Copyright {\textcopyright} 2022 Fern{\'a}ndez-Sarmiento, Wilches-Cuadros, Hernandez-Sarmiento, Mulett, Moreno-Medina, Molano, Dominguez, Acevedo, Salinas and Rivera.",

year = "2022",

month = jan,

day = "24",

doi = "10.3389/fped.2021.796504",

language = "English (US)",

volume = "9",

journal = "Frontiers in Pediatrics",

issn = "2296-2360",

publisher = "Frontiers Media S. A.",

}

Fernández-Sarmiento, J, Wilches-Cuadros, MA, Hernandez-Sarmiento, R, Mulett, H, Moreno-Medina, K, Molano, N, Dominguez, JAP, Acevedo, L, Salinas, C & Rivera, J 2022, 'Association Between Serum Lactate and Unsatisfactory Outcomes in Critically Ill Children in the Immediate Post-operative Period of Liver Transplantation', Frontiers in Pediatrics, vol. 9, 796504. https://doi.org/10.3389/fped.2021.796504

Association Between Serum Lactate and Unsatisfactory Outcomes in Critically Ill Children in the Immediate Post-operative Period of Liver Transplantation. / Fernández-Sarmiento, Jaime; Wilches-Cuadros, María Angélica; Hernandez-Sarmiento, Ricardo et al.
En: Frontiers in Pediatrics, Vol. 9, 796504, 24.01.2022.

Producción científica: Contribución a revista › Artículo de Investigación › revisión exhaustiva

TY - JOUR

T1 - Association Between Serum Lactate and Unsatisfactory Outcomes in Critically Ill Children in the Immediate Post-operative Period of Liver Transplantation

AU - Fernández-Sarmiento, Jaime

AU - Wilches-Cuadros, María Angélica

AU - Hernandez-Sarmiento, Ricardo

AU - Mulett, Hernando

AU - Moreno-Medina, Karen

AU - Molano, Nicolás

AU - Dominguez, Julián Augusto Palomar

AU - Acevedo, Lorena

AU - Salinas, Claudia

AU - Rivera, Jairo

PY - 2022/1/24

Y1 - 2022/1/24

N2 - Objectives: Serum lactate is a useful biomarker of tissue perfusion in critically ill patients. We evaluated the behavior of serum lactate in children in the pediatric intensive care unit (PICU) immediately after liver transplantation and its association with surgical complications, graft dysfunction and 90-day mortality. Materials and Methods: A prospective observational study carried out between November 2009 and December 2019. Multidisciplinary PICU at the University Children's Hospital, Fundación Cardioinfantil-IC, Bogotá, Colombia. Measurements and Main Results: Patients between 1 month and 18 years of age who were in the immediate post-operative period following living-donor or cadaveric liver transplantation were included. A total of 145 patients with a median age of 14 months (IQR 8–60) met the inclusion criteria. Biliary atresia was the main diagnosis in 56.5% of the cases. A serum lactate level > 3.0 mmol/L on admission to the PICU was associated with biliary complications (AUC 0.73 95% CI 0.54–0.93; p = 0.05) and mortality (AUC 0.72 95% CI 0.63–0.8; p = 0.01). A lactate level > 2 mmol/L after 6 h in the PICU was associated with mortality (AUC 0.70 95% CI 0.54–0.83; p = 0.02). Higher lactate levels and lack of clearance were associated with the presence of tardus et parvus waveforms (p = 0.001) on liver Doppler, primary dysfunction (p < 0.001), arterial thrombosis (p < 0.001) and neurological complications (p = 0.04). There was an inverse correlation between admission lactate and the volume of fluids administered during surgery (rho = 0.36; p < 0.001). A total procedure time > 350 min, along with a vasopressor score > 7 and elevated lactate, were associated with worse outcomes (p < 0.001). Conclusions: In post-operative pediatric liver transplant patients, the level of serum lactate is associated with post-operative surgical complications and mortality.

AB - Objectives: Serum lactate is a useful biomarker of tissue perfusion in critically ill patients. We evaluated the behavior of serum lactate in children in the pediatric intensive care unit (PICU) immediately after liver transplantation and its association with surgical complications, graft dysfunction and 90-day mortality. Materials and Methods: A prospective observational study carried out between November 2009 and December 2019. Multidisciplinary PICU at the University Children's Hospital, Fundación Cardioinfantil-IC, Bogotá, Colombia. Measurements and Main Results: Patients between 1 month and 18 years of age who were in the immediate post-operative period following living-donor or cadaveric liver transplantation were included. A total of 145 patients with a median age of 14 months (IQR 8–60) met the inclusion criteria. Biliary atresia was the main diagnosis in 56.5% of the cases. A serum lactate level > 3.0 mmol/L on admission to the PICU was associated with biliary complications (AUC 0.73 95% CI 0.54–0.93; p = 0.05) and mortality (AUC 0.72 95% CI 0.63–0.8; p = 0.01). A lactate level > 2 mmol/L after 6 h in the PICU was associated with mortality (AUC 0.70 95% CI 0.54–0.83; p = 0.02). Higher lactate levels and lack of clearance were associated with the presence of tardus et parvus waveforms (p = 0.001) on liver Doppler, primary dysfunction (p < 0.001), arterial thrombosis (p < 0.001) and neurological complications (p = 0.04). There was an inverse correlation between admission lactate and the volume of fluids administered during surgery (rho = 0.36; p < 0.001). A total procedure time > 350 min, along with a vasopressor score > 7 and elevated lactate, were associated with worse outcomes (p < 0.001). Conclusions: In post-operative pediatric liver transplant patients, the level of serum lactate is associated with post-operative surgical complications and mortality.

UR - https://www.scopus.com/pages/publications/85124213937

UR - https://www.scopus.com/pages/publications/85124213937#tab=citedBy

U2 - 10.3389/fped.2021.796504

DO - 10.3389/fped.2021.796504

M3 - Research Article

C2 - 35141179

AN - SCOPUS:85124213937

SN - 2296-2360

VL - 9

JO - Frontiers in Pediatrics

JF - Frontiers in Pediatrics

M1 - 796504

ER -

Association Between Serum Lactate and Unsatisfactory Outcomes in Critically Ill Children in the Immediate Post-operative Period of Liver Transplantation

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