{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,10]],"date-time":"2026-01-10T19:14:27Z","timestamp":1768072467652,"version":"3.49.0"},"reference-count":17,"publisher":"The Korean Society of Anesthesiologists","issue":"4","license":[{"start":{"date-parts":[[2021,10,14]],"date-time":"2021-10-14T00:00:00Z","timestamp":1634169600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100003710","name":"Korea Health Industry Development Institute","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100003710","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100003625","name":"Ministry of Health and Welfare","doi-asserted-by":"publisher","award":["HI18C2383"],"award-info":[{"award-number":["HI18C2383"]}],"id":[{"id":"10.13039\/501100003625","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["anesth-pain-med.org"],"crossmark-restriction":true},"short-container-title":["Anesth Pain Med"],"published-print":{"date-parts":[[2021,10,30]]},"abstract":"<jats:p>Background: Generally, lactate levels &gt; 2 mmol\/L represent hyperlactatemia, whereas lactic acidosis is often defined as lactate &gt; 4 mmol\/L. Although hyperlactatemia is common finding in liver transplant (LT) candidates, association between lactate and organ failures with Acute-on-chronic Liver Failure (ACLF) is poorly studied. We searched the important variables for pre-LT hyperlactatemia and examined the impact of preoperative hyperlactatemia on early mortality after LT. Methods: A total of 2,002 patients from LT registry between January 2008 and February 2019 were analyzed. Six organ failures (liver, kidney, brain, coagulation, circulation, and lung) were defined by criteria of EASL-CLIF ACLF Consortium. Variable importance of preoperative hyperlactatemia was examined by machine learning using random survival forest (RSF). Kaplan-Meier Survival curve analysis was performed to assess 90-day mortality.Results: Median lactate level was 1.9 mmol\/L (interquartile range: 1.4, 2.4 mmol\/L) and 107 (5.3%) patients showed &gt; 4.0 mmol\/L. RSF analysis revealed that the four most important variables for hyperlactatemia were MELD score, circulatory failure, hemoglobin, and respiratory failure. The 30-day and 90-day mortality rates were 2.7% and 5.1%, whereas patients with lactate &gt; 4.0 mmol\/L showed increased rate of 15.0% and 19.6%, respectively. Conclusion: About 50% and 5% of LT candidates showed pre-LT hyperlactatemia of &gt; 2.0 mmol\/L and &gt; 4.0 mmol\/L, respectively. Pre-LT lactate &gt; 4.0 mmol\/L was associated with increased early post-LT mortality. Our results suggest that future study of correcting modifiable risk factors may play a role in preventing hyperlactatemia and lowering early mortality after LT.<\/jats:p>","DOI":"10.17085\/apm.21049","type":"journal-article","created":{"date-parts":[[2021,10,14]],"date-time":"2021-10-14T05:30:30Z","timestamp":1634189430000},"page":"353-359","update-policy":"https:\/\/doi.org\/10.17085\/crossmark_policy","source":"Crossref","is-referenced-by-count":9,"title":["Preoperative hyperlactatemia and early mortality after liver transplantation: selection of important variables using random forest survival analysis"],"prefix":"10.17085","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7662-7158","authenticated-orcid":true,"given":"Yuseon","family":"Cheong","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5943-7715","authenticated-orcid":true,"given":"Sangho","family":"Lee","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6176-597X","authenticated-orcid":true,"given":"Do-Kyeong","family":"Lee","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6643-9177","authenticated-orcid":true,"given":"Kyoung-Sun","family":"Kim","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6890-4629","authenticated-orcid":true,"given":"Bo-Hyun","family":"Sang","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3627-1107","authenticated-orcid":true,"given":"Gyu-Sam","family":"Hwang","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"2573","reference":[{"key":"ref1","doi-asserted-by":"publisher","DOI":"10.1111\/liv.14083"},{"key":"ref2","doi-asserted-by":"publisher","DOI":"10.1053\/j.gastro.2018.12.007"},{"key":"ref3","first-page":"10","volume-title":"Surviving sepsis campaign international guidelines for the management of septic shock and sepsis-associated organ dysfunction in children","author":"Weiss","year":"2020"},{"key":"ref4","doi-asserted-by":"publisher","DOI":"10.3109\/00365513.2013.773591"},{"key":"ref5","first-page":"1038","volume-title":"CANONIC study investigators of the EASL-CLIF Consortium. Development and validation of a prognostic score to predict mortality in patients with acute-on-chronic liver failure","author":"Jalan","year":"2014"},{"key":"ref6","doi-asserted-by":"publisher","DOI":"10.1161\/circoutcomes.110.939371"},{"key":"ref7","doi-asserted-by":"publisher","DOI":"10.1016\/j.spl.2010.02.020"},{"key":"ref8","first-page":"191","volume-title":"Random survival forests analysis of intraoperative complications as predictors of descemet stripping automated endothelial keratoplasty graft failure in the cornea preservation time study","author":"O'Brien","year":"2021"},{"key":"ref9","doi-asserted-by":"publisher","DOI":"10.1007\/s00134-018-5085-0"},{"key":"ref10","doi-asserted-by":"publisher","DOI":"10.1002\/hep.30151"},{"key":"ref11","doi-asserted-by":"publisher","DOI":"10.1007\/s12072-017-9816-z"},{"key":"ref12","doi-asserted-by":"publisher","DOI":"10.1056\/nejmra1309483"},{"key":"ref13","doi-asserted-by":"publisher","DOI":"10.1002\/lt.20427"},{"key":"ref14","first-page":"851","volume-title":"UNOS\/OPTN Liver Disease Severity Score, UNOS\/OPTN Liver and Intestine, and UNOS\/OPTN Pediatric Transplantation Committees. The new liver allocation system: moving toward evidence-based transplantation policy","author":"Freeman","year":"2002"},{"key":"ref15","doi-asserted-by":"publisher","DOI":"10.1002\/ejhf.628"},{"key":"ref16","doi-asserted-by":"publisher","DOI":"10.1093\/biostatistics\/kxu010"},{"key":"ref17","doi-asserted-by":"publisher","DOI":"10.1002\/sam.11348"}],"container-title":["Anesthesia and Pain Medicine"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/anesth-pain-med.org\/upload\/pdf\/apm-21049.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"http:\/\/anesth-pain-med.org\/journal\/view.php?doi=10.17085\/apm.21049","content-type":"unspecified","content-version":"vor","intended-application":"text-mining"},{"URL":"http:\/\/anesth-pain-med.org\/upload\/pdf\/apm-21049.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,10,29]],"date-time":"2021-10-29T00:47:15Z","timestamp":1635468435000},"score":1,"resource":{"primary":{"URL":"http:\/\/anesth-pain-med.org\/journal\/view.php?doi=10.17085\/apm.21049"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,10,30]]},"references-count":17,"journal-issue":{"issue":"4","published-print":{"date-parts":[[2021,10]]}},"URL":"https:\/\/doi.org\/10.17085\/apm.21049","relation":{},"ISSN":["1975-5171","2383-7977"],"issn-type":[{"value":"1975-5171","type":"print"},{"value":"2383-7977","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,10,30]]},"assertion":[{"value":"2021-05-17","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2021-07-22","order":1,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2021-10-14","order":2,"name":"published","label":"Published online","group":{"name":"publication_history","label":"Publication History"}},{"value":"2021-10-30","order":3,"name":"published","label":"Print publication","group":{"name":"publication_history","label":"Publication History"}}]}}