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Background <p>Postoperative delirium is a frequent complication after cardiac surgery. The predictive value of initial lactate at ICU admission for cardiac surgery–associated postoperative delirium (CS-POD) remains unclear.</p> Methods <p>We conducted a retrospective cohort study using the eICU Collaborative Research Database, including adult patients admitted to the ICU after cardiac surgery. Multivariable logistic regression, restricted cubic spline analysis, ROC analysis, and mediation analysis were performed to assess the association between initial lactate and CS-POD and to explore whether disease severity scores (SOFA, APACHE IV) or clinical interventions statistically explained this relationship.</p> Results <p>Among 358 patients, 104 (29.1%) developed CS-POD. Higher initial lactate at ICU admission was independently associated with increased risk of CS-POD after full adjustment (OR per 1&#xa0;mmol/L increase: 1.37, 95% CI 1.11–1.69; <i>P</i> = 0.003). Restricted cubic spline analysis demonstrated a linear relationship between initial lactate and CS-POD risk (P for nonlinearity = 0.132). Adding initial lactate to the baseline prediction model improved discriminative performance, with the area under the ROC curve (AUC) increasing from 0.661 (95% CI, 0.598–0.723) to 0.717 (95% CI, 0.660–0.775) (DeLong test <i>P</i> = 0.012). The optimal lactate cutoff for predicting CS-POD was 2.385&#xa0;mmol/L. Mediation analysis indicated that part of the association between initial lactate and CS-POD was statistically explained by SOFA (proportion statistically explained: 17%, <i>P</i> = 0.002) and APACHE IV (proportion statistically explained: 7.7%, <i>P</i> = 0.034), whereas clinical interventions (IABP, RRT, opioid use) did not show significant mediation. Higher initial lactate levels were also associated with increased risks of acute kidney injury (OR 1.27, 95% CI 1.00–1.61) and in-hospital mortality (OR 2.88, 95% CI 1.52–5.46).</p> Conclusions <p>Higher initial lactate at ICU admission is associated with an increased risk of CS-POD and adverse postoperative outcomes. However, its predictive value is modest and should be interpreted cautiously as part of a broader clinical assessment rather than as an independent decision-making tool.</p>

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Admission lactate at ICU entry and the risk of postoperative delirium after cardiac surgery: a retrospective cohort study using the eICU-CRD database

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  • 发表日期：

    2026年5月7日

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  • Qiankun Yang,
  • ZhenGuo Luo,
  • Jing Li,
  • Gang Wu

摘要

Background

Postoperative delirium is a frequent complication after cardiac surgery. The predictive value of initial lactate at ICU admission for cardiac surgery–associated postoperative delirium (CS-POD) remains unclear.

Methods

We conducted a retrospective cohort study using the eICU Collaborative Research Database, including adult patients admitted to the ICU after cardiac surgery. Multivariable logistic regression, restricted cubic spline analysis, ROC analysis, and mediation analysis were performed to assess the association between initial lactate and CS-POD and to explore whether disease severity scores (SOFA, APACHE IV) or clinical interventions statistically explained this relationship.

Results

Among 358 patients, 104 (29.1%) developed CS-POD. Higher initial lactate at ICU admission was independently associated with increased risk of CS-POD after full adjustment (OR per 1 mmol/L increase: 1.37, 95% CI 1.11–1.69; P = 0.003). Restricted cubic spline analysis demonstrated a linear relationship between initial lactate and CS-POD risk (P for nonlinearity = 0.132). Adding initial lactate to the baseline prediction model improved discriminative performance, with the area under the ROC curve (AUC) increasing from 0.661 (95% CI, 0.598–0.723) to 0.717 (95% CI, 0.660–0.775) (DeLong test P = 0.012). The optimal lactate cutoff for predicting CS-POD was 2.385 mmol/L. Mediation analysis indicated that part of the association between initial lactate and CS-POD was statistically explained by SOFA (proportion statistically explained: 17%, P = 0.002) and APACHE IV (proportion statistically explained: 7.7%, P = 0.034), whereas clinical interventions (IABP, RRT, opioid use) did not show significant mediation. Higher initial lactate levels were also associated with increased risks of acute kidney injury (OR 1.27, 95% CI 1.00–1.61) and in-hospital mortality (OR 2.88, 95% CI 1.52–5.46).

Conclusions

Higher initial lactate at ICU admission is associated with an increased risk of CS-POD and adverse postoperative outcomes. However, its predictive value is modest and should be interpreted cautiously as part of a broader clinical assessment rather than as an independent decision-making tool.