Analysis of risk factors and adverse outcomes for hyperlacidemia following acute Stanford A aortic dissection

Acute Stanford type A aortic dissection (ATAAD) is associated with a high mortality rate. Postoperative hyperlactatemia is significant in predicting mortality and the incidence of major complications. A retrospective analysis was conducted on 337 ATAAD patients admitted to the Cardiothoracic Surgery Department of Ningxia Hui Autonomous Region People's Hospital from January 2017 to December 2024. According to the highest lactate level measured in the ICU within 12 hours postoperatively, patients were divided into a non-hyperlactatemia group (≤4 mmol/L) and a hyperlactatemia group (>4 mmol/L). Univariate and multivariate logistic regression analyses were performed to identify independent risk factors for postoperative hyperlactatemia. Potential risk factors identified in univariate analysis, along with those considered clinically significant, were included in the multivariate logistic regression analysis, which demonstrated that hypertension（OR = 2.016, P = 0.032), preoperative NYHA heart function classification （OR = 2.059, P = 0.029, surgical time (OR = 1.011, P = 0.000, CPB（OR = 1.009, P = 0.039), and DHCA （OR = 1.057, P = 0.002） were independent risk factors for postoperative hyperlactatemia. The combined predictive capability of these independent risk factors exhibited greater predictive value than each indicator alone (P < 0.05), with a sensitivity of 94.5%, specificity of 61.7%, and AUC of 0.836. Postoperative data comparison indicated a higher incidence of continuous renal replacement therapy (CRRT) and hospitalization mortality in the hyperlactatemia group (P < 0.05). However, postoperative hyperlacidemia did not significantly prolong the hospital stay in the ICU; the incidence of major adverse cardiovascular events in the ICU prolonged group (≥ 7 days) was significantly higher than that in the routine hospitalization group (< 7 days) (P < 0.05). The cause of death in the ICU prolonged group was sepsis first, followed by major adverse cardiovascular events. Postoperative hyperlactatemia is common in ATAAD. Effectively addressing the risk factors leading to postoperative hyperlactatemia may help reduce the occurrence of adverse events and enhance clinical outcomes.