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Development and validation of a nomogram model for early postoperative hyperlactatemia in patients undergoing cardiac surgery
BACKGROUND: Postoperative hyperlactatemia (POHL) is common in patients undergoing cardiac surgery, associated with adverse outcomes. The aim of this study was to identify predictors for POHL after cardiac surgery and to develop and validate a predictive model. METHODS: Adult patients who underwent o...
Autores principales: | , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
AME Publishing Company
2021
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8482329/ https://www.ncbi.nlm.nih.gov/pubmed/34659806 http://dx.doi.org/10.21037/jtd-21-1004 |
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author | Wang, Su Wang, Dashuai Huang, Xiaofan Wang, Hongfei Le, Sheng Zhang, Jinnong Du, Xinling |
author_facet | Wang, Su Wang, Dashuai Huang, Xiaofan Wang, Hongfei Le, Sheng Zhang, Jinnong Du, Xinling |
author_sort | Wang, Su |
collection | PubMed |
description | BACKGROUND: Postoperative hyperlactatemia (POHL) is common in patients undergoing cardiac surgery, associated with adverse outcomes. The aim of this study was to identify predictors for POHL after cardiac surgery and to develop and validate a predictive model. METHODS: Adult patients who underwent open heart surgery at our institution between 2016 and 2019 were retrospectively included. The patients were randomly divided into training and validation groups at a 2:1 ratio. Multivariate logistic regression was performed to identify independent predictors for POHL in the training set. A nomogram was then constructed and was validated in the validation set. RESULTS: POHL developed in 713 of the 5,323 patients (13.4%). The mortality rate was higher in patients with POHL compared with patients without that (9.5% vs. 2.1%, P<0.001). Age, white blood cell (WBC) count, left ventricular ejection fraction, renal insufficiency, cardiac surgery history, red blood cell (RBC) transfusion, and cardiopulmonary bypass (CPB) time were identified as independent risk factors. The nomogram based on these predictors indicated good discrimination in both the training (c-index: 0.787) and validation (c-index: 0.820) sets. The calibration was reasonable by both visual inspection and goodness-of-fit test. The decision and clinical impact curves demonstrated good clinical utility. CONCLUSIONS: We identified 7 independent risk factors and derived a prediction model for POHL in patients undergoing cardiac surgery. The model may contribute significantly to early risk assessment and clinical intervention. |
format | Online Article Text |
id | pubmed-8482329 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2021 |
publisher | AME Publishing Company |
record_format | MEDLINE/PubMed |
spelling | pubmed-84823292021-10-14 Development and validation of a nomogram model for early postoperative hyperlactatemia in patients undergoing cardiac surgery Wang, Su Wang, Dashuai Huang, Xiaofan Wang, Hongfei Le, Sheng Zhang, Jinnong Du, Xinling J Thorac Dis Original Article BACKGROUND: Postoperative hyperlactatemia (POHL) is common in patients undergoing cardiac surgery, associated with adverse outcomes. The aim of this study was to identify predictors for POHL after cardiac surgery and to develop and validate a predictive model. METHODS: Adult patients who underwent open heart surgery at our institution between 2016 and 2019 were retrospectively included. The patients were randomly divided into training and validation groups at a 2:1 ratio. Multivariate logistic regression was performed to identify independent predictors for POHL in the training set. A nomogram was then constructed and was validated in the validation set. RESULTS: POHL developed in 713 of the 5,323 patients (13.4%). The mortality rate was higher in patients with POHL compared with patients without that (9.5% vs. 2.1%, P<0.001). Age, white blood cell (WBC) count, left ventricular ejection fraction, renal insufficiency, cardiac surgery history, red blood cell (RBC) transfusion, and cardiopulmonary bypass (CPB) time were identified as independent risk factors. The nomogram based on these predictors indicated good discrimination in both the training (c-index: 0.787) and validation (c-index: 0.820) sets. The calibration was reasonable by both visual inspection and goodness-of-fit test. The decision and clinical impact curves demonstrated good clinical utility. CONCLUSIONS: We identified 7 independent risk factors and derived a prediction model for POHL in patients undergoing cardiac surgery. The model may contribute significantly to early risk assessment and clinical intervention. AME Publishing Company 2021-09 /pmc/articles/PMC8482329/ /pubmed/34659806 http://dx.doi.org/10.21037/jtd-21-1004 Text en 2021 Journal of Thoracic Disease. All rights reserved. https://creativecommons.org/licenses/by-nc-nd/4.0/Open Access Statement: This is an Open Access article distributed in accordance with the Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International License (CC BY-NC-ND 4.0), which permits the non-commercial replication and distribution of the article with the strict proviso that no changes or edits are made and the original work is properly cited (including links to both the formal publication through the relevant DOI and the license). See: https://creativecommons.org/licenses/by-nc-nd/4.0 (https://creativecommons.org/licenses/by-nc-nd/4.0/) . |
spellingShingle | Original Article Wang, Su Wang, Dashuai Huang, Xiaofan Wang, Hongfei Le, Sheng Zhang, Jinnong Du, Xinling Development and validation of a nomogram model for early postoperative hyperlactatemia in patients undergoing cardiac surgery |
title | Development and validation of a nomogram model for early postoperative hyperlactatemia in patients undergoing cardiac surgery |
title_full | Development and validation of a nomogram model for early postoperative hyperlactatemia in patients undergoing cardiac surgery |
title_fullStr | Development and validation of a nomogram model for early postoperative hyperlactatemia in patients undergoing cardiac surgery |
title_full_unstemmed | Development and validation of a nomogram model for early postoperative hyperlactatemia in patients undergoing cardiac surgery |
title_short | Development and validation of a nomogram model for early postoperative hyperlactatemia in patients undergoing cardiac surgery |
title_sort | development and validation of a nomogram model for early postoperative hyperlactatemia in patients undergoing cardiac surgery |
topic | Original Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8482329/ https://www.ncbi.nlm.nih.gov/pubmed/34659806 http://dx.doi.org/10.21037/jtd-21-1004 |
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