Prediction of the Postoperative Outcome in Liver Resection Using Perioperative Serum Lactate Levels

Sebastian Recknagel; Sebastian Rademacher; Claudia Höhne; Andri A Lederer; Undine G Lange; Toni Herta; Daniel Seehofer; Robert Sucher; Uwe Scheuermann

doi:10.3390/jcm12062100

Prediction of the Postoperative Outcome in Liver Resection Using Perioperative Serum Lactate Levels

J Clin Med. 2023 Mar 7;12(6):2100. doi: 10.3390/jcm12062100.

Authors

Sebastian Recknagel¹, Sebastian Rademacher¹, Claudia Höhne², Andri A Lederer¹, Undine G Lange¹, Toni Herta³, Daniel Seehofer¹, Robert Sucher¹, Uwe Scheuermann¹

Affiliations

¹ Department of Visceral, Transplantation, Vascular and Thoracic Surgery, University Hospital of Leipzig, 04103 Leipzig, Germany.
² Department of Anesthesiology, Pain Therapy, Intensive Care and Emergency Medicine, DRK Hospital Berlin-Koepenick, 12559 Berlin, Germany.
³ Department of Gastroenterology and Oncology, Division of Hepatology, University Hospital Leipzig, 04103 Leipzig, Germany.

Abstract

Background: The aim of our study was to analyze perioperative lactate levels and their predictive value for postoperative mortality and morbidity after liver resection.

Methods: The clinicopathological characteristics and outcomes of 152 patients who underwent liver resection for benign and malign diagnoses were analyzed retrospectively. Lactate concentrations at three different time points, (1) before liver resection (LAC-PRE), (2) after liver resection on day 0 (LAC-POST), and (3) on day one after the operation (LAC-POD1) were assessed regarding the prognostic value in predicting postoperative complications and mortality according to the Clavien-Dindo (CD) classification.

Results: The rates of postoperative complications (CD ≥ IIIb) and mortality rates were 19.7% (N = 30) and 4.6% (N = 7), respectively. The LAC-PRE levels showed no correlation with the postoperative outcome. The ROC curve analysis showed that LCT-POST and LCT-POD1 values were moderately strong in predicting postoperative morbidity (0.681 and 0.768, respectively) and had strong predictive accuracies regarding postoperative mortality (0.800 and 0.838, respectively). The multivariate analysis revealed LAC-POST as a significant predictor of postoperative complications (CD ≥ IIIb: OR 9.28; 95% CI: 2.88-29.9; p < 0.001) and mortality (OR 11.69; 95% CI: 1.76-77.7; p = 0.011).

Conclusion: Early postoperative lactate levels are a useful and easily practicable predictor of postoperative morbidity and mortality in patients after liver resection.

Keywords: Clavien–Dindo classification; complication; lactate; liver resection; morbidity; mortality; outcome; prognostic factor.

Grants and funding

This work was supported by the Open Access Publication Fund of the University of Leipzig. The funders had no role in the study design, data collection and analysis, decision to publish, or preparation of the manuscript. There are no potential conflicts of interest arising from associations with commercial or corporate interests in connection with the work submitted.