Early Detection of Morbidity following Liver Resection by Serum Arterial Lactate Concentration: A Cross-sectional Study

Abstract

Background: Liver resection is a technically demanding procedure with a relatively high risk of morbidity. Identifying reliable early predictors of postoperative complications is essential for timely intervention and improved outcomes. Objective: The aim of the study was to evaluate the role of initial serum arterial lactate concentration (ALC) in predicting early postoperative liver and renal dysfunction following liver resection (LR). Methodology: This cross-sectional study was conducted in the Department of Hepatobiliary, Pancreatic and Liver Transplant Surgery at Bangladesh Medical University, Dhaka, Bangladesh from September 2022 to August 2023. Thirty‑seven patients undergoing LR for various indications were included. Pre‑ and postoperative assessments of liver function, coagulation profile, and renal function were performed. Renal dysfunction was defined as a creatinine rise >1.5× baseline, while liver dysfunction was defined as bilirubin >2 mg/dL, prothrombin time >17 s, or INR ≥1.5. Arterial lactate samples were obtained at the end of surgery, prior to abdominal closure or upon arrival in the high dependency ward. Results: The mean ALC was 3.97 ± 1.28 mmol/L (range 1.67–6.30), with elevated levels (≥4 mmol/L) observed in 15 patients (40.5%). Overall, 19 patients (51.3%) had an uncomplicated recovery, while 13 (35.1%) developed liver dysfunction and 8 (21.6%) developed renal dysfunction. The probability of dysfunction increased progressively with rising lactate concentration, reaching 100% for liver dysfunction and 66% for renal dysfunction at lactate ≥6 mmol/L. Chi‑square and Fisher’s exact tests confirmed significant associations between lactate ≥4 mmol/L and both liver dysfunction (P = 0.001) and renal dysfunction (P = 0.000). Regression analysis demonstrated a strong correlation between initial lactate and peak prothrombin time (P = 0.016) and a highly significant correlation with renal dysfunction (P = 0.003), while associations with bilirubin and hospital stay were weak. Operative factors such as anatomical and major resections, nodular parenchyma, and male gender were independently associated with elevated lactate levels. Conclusion: Elevated postoperative arterial lactate (≥4 mmol/L) was a strong independent predictor of liver and renal dysfunction, correlating significantly with adverse outcomes and operative factors. Bangladesh Journal of Infectious Diseases, June 2026;13(1):375-385