Lactate, endothelin, and central venous oxygen saturation as predictors of mortality in patients with Tetralogy of Fallot.
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Date
2016-04
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Abstract
Background: Lactate and central venous oxygen saturation (ScVO2) are well known biomarkers for adequacy
of tissue oxygenation. Endothelin, an inflammatory marker has been associated with patient’s nutritional
status and degree of cyanosis. The aim of this study was to explore the hypothesis that lactate, ScVO2
and endothelin before induction may be predictive of mortality in pediatric cardiac surgery. Methods: We
conducted a prospective observational study of 150 pediatric (6 months to 12 years) patients who were posted
for intracardiac repair for tetralogy of fallot and measured lactate, ScVO2 and endothelin before induction
(T1), 20 minutes after protamine administration (T2) and 24 hours after admission to ICU (T3). Results:
Preinduction lactate and endothelin levels were found to predict mortality in patients of tetralogy of fallot
with an odds ratio of 6.020 (95% CI 2.111-17.168) and 1.292(95% CI 1.091-1.531) respectively. In the ROC
curve analysis for lactate at T1, the AUC was 0.713 (95% CI 0.526–0.899 P = 0.019). At the cutoff value of
1.750mmol/lt, the sensitivity and specificity for the prediction of mortality was 63.6% and 65.5%, respectively.
For endothelin at T1, the AUC was 0.699 (95% CI 0.516–0.883, P = 0.028) and the cutoff value was ≤2.50
(sensitivity, 63.6%; specificity, 58.3 %). ScVO2 (odds ratio 0.85) at all three time intervals, suggested that
improving ScVO2 can lead to 15% reduction in mortality. Conclusions: Lactate, ScVO2 and endothelin all
showed association with mortality with lactate having the maximum prediction. Lactate was found to be an
independent, reliable and cost-effective measure of prediction of mortality in patients with tetralogy of fallot.
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Keywords
Central venous oxygen saturation, Epinephrine, Liver disease, Thiamine deficiency
Citation
Kapoor Poonam Malhotra, Dhawan Ira, Jain Pawan, Chowdhury Ujjwal. Lactate, endothelin, and central venous oxygen saturation as predictors of mortality in patients with Tetralogy of Fallot. Annals of Cardiac Anaesthesia. 2016 Apr; 19(2): 269-276.