Serum lactate changes and its correlation with serum liver tests in liver transplant patients
Keywords:
Liver transplant, Serum lactate, Intensive CareAbstract
Objective: To study the correlation between serum lactate levels and
complications in the immediate post-operative phase of orthotopic liver transplant (OLT).
Setting: medical-surgical intensive care unit with 14 beds
Design: retrospective case-control study
Methods: 43 patients who underwent OLT were included in the
study. Twenty-three patients had a favourable evolution and constituted the control group; 20 patients presented complications (9 of which were vascular) and were classified in 2 sub-groups based on
serum liver parameters: hepatocellular (aminotransferase elevations)
and cholestatic (serum elevation of gama-glutamyl transpeptidase
and bilirubin). The following parameters were evaluated: age, gender, hospitalization and mechanical ventilation duration, APACHE II and SAPS II scores. The initial serum values of several biochemical
parameters were registered and compared when an increase was
found (1.5 - 2 times the prior value).
Results: The patients with complications were predominantly female (p=0.047), presented longer hospitalization time (p<0.001) and
had higher SAPS II scores (p<0.001). The initial lactate values were
higher in the complicated group (9.4 versus 6.7 mmol/L, p=0.0046).
Vascular complications correlated with a hepatocellular pattern. A
1.5 fold increase in lactate correlated with any complication and a
2-fold increase with hepatocellular complications. Using multivariate
analysis, this variation in serum lactate was independently related to
occurrence of any complication (CI 1.18-1.64, p=0.003).
Conclusions: Complicated post-OLT patients presented a higher
initial lactate value. Post-operative complications in the ICU correlated with 1.5-fold increase in serum lactate, while a 2-fold increase
correlated with hepatocellular complications, especially those of
vascular origin. Serum lactate may be a useful monitoring tool of
complications in OLT patients in the ICU
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