Monitoring of the Progression of the Perioperative Serum Lactate Concentration Improves the Accuracy of the Prediction of Acute Mesenteric Ischemia Development After Cardiovascular Surgery

Abstract Objectives To examine the sensitivity and specificity of perioperative lactate gradients for the prediction of subsequent acute mesenteric ischemia development in patients undergoing cardiovascular surgery. Design Retrospective single-center case-control study. Setting University hospital. Participants One hundred eight (1.15%) patients with acute mesenteric ischemia selected from 9385 patients who underwent cardiovascular surgery were matched to 324 controls by age and operation type. Interventions None. Measurements and Main Results Univariate and logistic regression analyses were used to examine intraoperative and early postoperative lactate levels in patients with and without mesenteric ischemia after cardiac surgery. Late intraoperative lactate concentrations were significantly higher in patients who subsequently developed mesenteric ischemia (P 3 mmol/L had a fourfold increased risk of mesenteric ischemia development [odds ratio (OR) 4.2, 95% confidence interval (CI) 2.4-7.5; area under the curve (AUC) 0.597; P 3 mmol/L on the first postoperative day had a nearly eightfold increased risk (OR 7.8, 95% CI 4.6-13.3; AUC 0.68; P 200% increase between the intraoperative and early postoperative periods (OR 4.1, 95% CI 2.4-6.8; AUC 0.62; P Conclusion Late intraoperative and early postoperative lactate levels > 3 mmol/L, and increases > 200%, even when remaining within the normal range, should raise the suspicion of subsequent mesenteric ischemia development.