Affiliations: University Children’s Hospital, Muenster, Germany,
Centre Cardiologique de Nord, Saint-Denis, France
Correspondence to: Thomas Krasemann, MD, University Children’s Hospital, Department of Pediatric Cardiology, Albert-Schweitzer Str 33, D-48149 Muenster, Germany; e-mail: email@example.com
To the Editor:
The article by Maillet and colleagues (May 2003)1–
needs a short comment. It is often necessary to transfuse blood products during cardiac surgery. While in adults the ratio of transfused blood to the patient’s own blood is not as important, in children (and especially in small infants) the quantity of transfused blood might be as high or even higher than that of their own blood (eg, for cardiopulmonary bypass). The longer that blood concentrates are stored, the higher are the levels of potassium, glucose, and lactic acid.2
Thus, transfusion itself influences the level of lactate, which was (according to the authors) a predictor of higher postoperative risk.
have shown that transfusion itself is a risk factor for patients in an ICU. In the article by Maillet et al,1
the transfusion rate was not mentioned as a possible risk. Fixing the predictors of mortality is very difficult when they are influenced by several factors.
We appreciate the interest in our article. We agree with your comment concerning the importance of the effect of transfusion on lactate level and risk factor for patients in the ICU. We apologize for missing these potentially important data.
In our study, intraoperative transfusion rates were comparable for patients with no hyperlactatemia (11.4%) and those with late hyperlactatemia (15%; difference not significant). The transfusion rate for patients with immediate hyperlactatemia (IHL) was statistically higher compared to both those groups (30%; p < 0.05). Multivariate analysis of IHL was not significantly modified when transfusion was included in the new model.
It is true that “to fix predictors of mortality is very difficult.” The aim of our study was not to identify independent risk factors of mortality after cardiac surgery. It was to evaluate whether lactate levels, but especially the timing of their acquisition, permitted the stratification of patients with different postoperative risks.
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