Serial blood lactate measurements predict early outcome after neonatal repair or palliation for complex congenital heart disease
Open accessAbstract
Objectives Neonates with congenital heart disease may appear hemodynamically stable after operation and then suddenly experience catastrophic decompensation. An improved means of predicting which infants will suddenly die in the early postoperative period may lead to lifesaving interventions. Studies indicate that blood lactate level is proportional to tissue oxygen debt, but information linking lactate levels with outcome in infants after operation is limited. We sought to determine whether a change in lactate level over time was predictive of a poor outcome defined as death within the first 72 hours or the need for extracorporeal membrane oxygenation.Methods To test this hypothesis, we studied prospectively 46 infants who were less than 1 month old and were undergoing complex cardiac surgical palliation or repair. Postoperative arterial oxygen saturation, bicarbonate, and lactate levels were recorded on admission to the intensive care unit and every 3 to 12 hours for the first 3 days.Results Thirty-seven patients had a good outcome, and 9 patients had a poor outcome. Mean initial lactate level was significantly greater in patients with a poor outcome (9.4 +/- 3.8 mmol/L) than in patients with a good outcome (5.6 +/- 2.1 mmol/L; P =.03). However, an elevated initial lactate level of more than 6 mmol/L had a low positive predictive value (38%) for poor outcome. In contrast, a change in lactate level of 0.75 mmol/L per hour or more was associated with a poor outcome (P <.0001) and predicted a poor outcome with an 89% sensitivity value, a 100% specificity value, and a 100% positive predictive value.Conclusions Serial blood lactate level measurements may be an accurate predictor of death or the requirement for extracorporeal membrane oxygenator support for patients who undergo complex neonatal cardiac surgery.
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Elevated lactate concentrations have been associated with increased mortality and a higher risk for requiring ECMO post-cardiac surgery.
“Elevated lactate concentrations have been associated with increased mortality and a higher risk for requiring ECMO post-cardiac surgery [34].”
From Trends and Challenges in Noninvasive Hemodynamic Monitoring of Neonates Following Cardiac Surgery: A Narrative Review (2025) · cites this paper as [34]
The Results report higher initial lactate in neonates who died or required ECMO after complex cardiac surgery, and a rising lactate level was associated with that combined outcome. The claim omits the study’s neonatal, high-risk setting; the Discussion says the authors did not know whether the findings generalized beyond those patients. It also does not distinguish the stronger association for rising serial lactate from the low predictive value of a single elevated initial level. (LLM, conf=0.84)
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- Authors
- Charpie, J. R., Dekeon, M. K., Goldberg, C. S., Mosca, R. S., Bove, E. L., & Kulik, T. J.
- Affiliations
- University of Michigan (US)
- Venue
- The Journal of Thoracic and Cardiovascular Surgery
- Publisher
- Elsevier BV
- Published
- 2000-07
- Volume
- 120
- Issue
- 1
- Pages
- 73-80
- ISSN
- 0022-5223 (ISSN-L)
- OpenAlex
- W2150050635
- Cited by
- 198
- References
- 28
- Citations by year
- 2026: 3 · 2025: 7 · 2024: 4 · 2023: 7 · 2022: 9 · 2021: 6 · 2020: 6 · 2019: 4 · 2018: 8 · 2017: 10 · 2016: 11 · 2015: 4 · 2014: 5 · 2013: 8 · 2012: 14
- FWCI
- 4.01
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- Locations
- Journal of Thoracic and Cardiovascular Surgery (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Epidemiology › Congenital Heart Disease Studies
- Health Sciences › Medicine › Radiology, Nuclear Medicine and Imaging › Cardiovascular Conditions and Treatments
- Health Sciences › Medicine › Surgery › Cardiac and Coronary Surgery Techniques
- Keywords
- blood lactate, neonatal cardiac surgery, complex congenital heart disease, postoperative outcome prediction, early mortality, extracorporeal membrane oxygenation, tissue hypoxia, positive predictive value
- MeSH terms
- Heart Defects, Congenital, Humans, Infant, Newborn, Palliative Care, Predictive Value of Tests, Prospective Studies, Sensitivity and Specificity, Time Factors, Extracorporeal Membrane Oxygenation, Treatment Outcome, Lactic Acid
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