Relationship between peak lactate and patient outcome following high-risk gastrointestinal surgery: Influence of the nature of their surgery: Elective versus emergency

Objectives: The association between hyperlactatemia and adverse outcome in patients admitted to ICUs following gastrointestinal surgery has not been reported. To explore the hypothesis that in a large cohort of gastrointestinal surgical patients, the peak serum lactate (in the first 24 hr) observed in patients admitted to ICU following surgery is associated with unadjusted and severity-adjusted acute hospital mortality and that the strength of association is greater in patients admitted following “emergency” surgery than in patients admitted following “elective” surgery. Design: A retrospective cohort study of all patients who had gastrointestinal surgery and were admitted directly to the ICU between 2008 and 2012. Setting: Two hundred forty-nine hospitals in the United Kingdom. Patients: One hundred twenty-one thousand nine hundred ninety patients. Interventions: None. Measurements and Main Results: Peak blood lactate in the first 24 hours of admission to critical care, acute hospital mortality, length of stay, and other variables routinely collected within the U.K. Intensive Care National Audit and Research Centre Case Mix Programme database. Elevated blood lactate was associated with increased risk of death and prolonged duration of stay, and the relationship was maintained once adjusted for confounding variables. The positive association between mortality and levels of blood lactate continued down into the “normal range,” without evidence of a plateau. There was no difference in the extent to which hyperlactatemia was related to mortality between patients admitted following elective and emergency surgery. Conclusions: These findings have implications for our understanding of the role of lactate in critically ill patients.