High Intraoperative Serum Lactate Level is Associated with Acute Kidney Injury after Brain Tumor Resection

Abstract

Background: Postoperative acute kidney injury (AKI) is associated with poor clinical outcomes. Identification of risk factors for postoperative AKI is clinically important. Serum lactate can increase in situations of inadequate oxygen delivery and is widely used to assess a patient’s clinical course. We investigated the association between intraoperative serum lactate levels and AKI after brain tumor resection. Methods: Demographics, medical and surgical history, tumor characteristics, surgery, anesthesia, preoperative and intraoperative blood test results, and postoperative clinical outcomes were retrospectively collected from 4131 patients who had undergone brain tumor resection. Patients were divided into high (n=1078) and low (n=3053) lactate groups based on an intraoperative maximum serum lactate level of 3.35 mmol/L. After propensity score matching, 1005 patients were included per group. AKI was diagnosed using the Kidney Disease Improving Global Outcomes criteria, based on serum creatinine levels within 7 days after surgery. Results: Postoperative AKI was observed in 53 (1.3%) patients and was more frequent in those with high lactate both before (3.2% [n=35] vs. 0.6% [n=18]; P < 0.001) and after (3.3% [n=33] vs. 0.6% [n=6]; P < 0.001) propensity score matching. Intraoperative predictors of postoperative AKI were maximum serum lactate levels > 3.35 mmol/L (odds ratio [95% confidence interval], 3.57 [1.45–8.74], P = 0.005), minimum blood pH (odds ratio per 1 unit, 0.01 [0.00–0.24], P = 0.004), minimum hematocrit (odds ratio per 1%, 0.91 [0.84–1.00], P = 0.037), and mean serum glucose levels > 200 mg/dL (odds ratio, 6.22 [1.75–22.16], P = 0.005). Conclusion: High intraoperative serum lactate levels were associated with AKI after brain tumor resection.