Close Correlations Between Serum Lactate and Blood Glucose Fluctuations in Children Undergoing Open-Heart Surgery: A Prospective Observational Study

Document Type : Original Article


1 Cardiac Anesthesia Department, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, IR Iran.

2 Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, IR Iran.


Background: Changes and increases in blood glucose and lactate during and after cardiac surgery in the intensive care unit (ICU) can be associated with complications. Recognizing these changes during and after surgery can be significant.
Methods: The present prospective observational case-series study assessed 163 children aged between 1 and 170 months undergoing open-heart surgery on cardiopulmonary bypass (CPB) over a 3-month period. Blood glucose and lactate were assessed using arterial blood samples before surgery, during surgery (at 15 and 45 minutes on CPB, after warm-up, and after sternum closure), and at 1, 6, 12, 24, and 48 hours after admission to the ICU.
Results: In the first hour following ICU admission, a significant number of patients needed inotropes. Also at this time point, the percentage of patients with lactate levels >2.5 mmol/L was higher than that at the other time points. Further, most changes in blood glucose and lactate occurred in the first 6 hours following ICU admission. A significant relationship existed between changes in blood sugar and serum lactate in the first 6 hours post-ICU admission (P<0.001).
Conclusions: The results demonstrated a significant relationship between changes in blood glucose and serum lactate in the first 6 hours following ICU admission. (Iranian Heart Journal 2023; 24(1): 45-53)


  1. Jennifer J. Verhoeven, Anita C. S. Hokken-Koelega, Marieke den Brinker, Wim C. J. Hop, Robert J. van Thiel, Ad J. J. C. Bogers, Wim A. Helbing, and Koen F. M. Joosten , Disturbance of Glucose Homeostasis After Pediatric Cardiac Surgery,PediatrCardiol. 2011 Feb; 32(2): 131–138.
  2. Şahutoğlu C, Yaşar A, Kocabaş S, ZekiyeAşkar F, FatihAyık M, Atay Y, Correlation between serum lactate levels and outcome in pediatric patients undergoing congenital heart surgery, Turkish Journal of Thoracic and Cardiovascular Surgery 2018; 26(3):375-385.
  3. Minton J, Sidebotham DA. Hyperlactatemia and CardiacSurgery. J Extra CorporTechnol 2017; 49:7-15.
  4. Yılmaz S, Yurtseven N, Tuygun AK, Yavuz Y, CanikS.Hyperlactatemia after coronary artery bypass surgery: riskfactors and effect on mortality. Turk GogusKalpDama 2011; 19:30-5.
  5. Schumacher KR, Reichel RA, Vlasic JR, Yu S, Donohue J,Gajarski RJ, et al. Rate of increase in serum lactate level riskstratifiesinfants after surgery for congenital heart disease. J ThoracCardiovascSurg 2014; 148:589-95.
  6. Ghaffari S, Malaki M. Arterial lactate level changes infirst day after cardiac operation. J CardiovascThorac Res 2013; 5:143-5
  7. Julia J. Krueger J, , Barbara Brotschi, , Christian Balmer, , Vera Bernet, ,*, and Beatrice Latal, ,*Postoperative Hyperglycemia and 4-Year Neurodevelopmental Outcome in Children Operated for Congenital Heart Disease, J Pediatr 2015; 167:1253-8
  8. Alaei F , NakhostinDavari P , Alaei M, Azarfarin R , Soleymani,E, Postoperative Outcome for Hyperglycemic Pediatric Cardiac Surgery Patients, Pediatric Cardiology, 2012 ; 33: 21–26
  9. Polito, A, Thiagarajan P, Laussen, P, Gauvreau K, Agus M, Scheurer M, Pigula F, Costello J, Association Between Intraoperative and Early Postoperative Glucose Levels and Adverse Outcomes After Complex Congenital Heart Surgery, Circulation. 2008; 118:2235-2242
  10. Ödek C, Kendirli T, Yıldırım-Yıldız N, Yaman A, Uçar T, Eyileten Z, Ateş C, Uysalel, ErcanTutar A, Atalay S, Perioperative factors associated with hyperglycemia after pediatric cardiac surgery and impact of hyperglycemia on morbidity and mortality, the Turkish Journal of Pediatrics 2018; 60: 497-505
  11. Molina Hazan V, Gonen Y, Vardi A, Keidan I, MishaliD, Rubinshtein M, et al. Blood lactate levels differ significantlybetween surviving and nonsurviving patients within the samerisk-adjusted Classification for Congenital Heart Surgery(RACHS-1) group after pediatric cardiac surgery. PediatrCardiol 2010; 31:952-60.
  12. Maarslet L, Møller MB, Dall R, Hjortholm K, RavnH.Lactate levels predict mortality and need for peritonealdialysis in children undergoing congenital heart surgery. ActaAnaesthesiolScand 2012; 56:459-64
  13. Agrawal A, Agrawal N, Das J, Varma A. Point of care serum lactate levels as a prognostic marker of outcome in complex pediatric cardiac surgery patients: Can we utilize it? Indian journal of critical care medicine: peer-reviewed, official publication of Indian Society of Critical Care Medicine. 2012; 16(4):193-7. Epub 2013/04/06
  14. Oğuz S, Bozoğlan O, Serhatlıoğlu F, Erdem K, Ceyran H. The Relationship of Hyperlactatemia Following Paediatric Open Heart Surgery with Mortality, Morbidity and Risk Factors. Correspondance. 2013.
  15. Alavi M, Hadipourzadeh F, Azarfarin R, Babaee T, Ziyaeifard M, Effects of Advanced Hemodynamic Monitoring on the Postoperative Intubation Time in Patients With Moderate-to-Severe Left Ventricular Dysfunction Undergoing Cardiac Surgery; Iranian Heart Journal; 2020; 21 (4)
  16. Ziyaeifard M, Alizadehasl A, Aghdaii N, Rahimzadeh P, Masoumi G, Golzari S, Fatahi M, and Gorjipur F. The effect of combined conventional and modified ultrafiltration on mechanical ventilation and hemodynamic changes in congenital heart surgery. J Res Med Sci. 2016 Nov 7; 21: 113. doi: 10.4103/1735-1995.193504