Supplementary file 1_Postoperative lactate trajectories predict in-hospital adverse outcomes and differ by surgical approach in cardiac surgery: a propensity score-matched study.docx

TTCS was independently associated with reduced odds of Moderate-Resolving (adjusted odds ratio [aOR] 0.70, 95% CI 0.54–0.90) and PE membership (aOR 0.27, 95% CI 0.15–0.49), with the protective association more pronounced for PE. PE trajectory independently predicted MACE (aOR 14.73, 95% CI 7.91–27.45) and mechanical ventilation exceeding 48 h (aOR 20.79). Exploratory path decomposition attributed 24.0%–42.3% of the total association to indirect pathways, though estimates were sensitive to unmeasured confounding.

T2h lactate independently predicted MACE (aOR 2.18 per mmol/L; AUC 0.697; optimal cut-off 2.45 mmol/L). All five inflammatory and organ-function biomarkers showed trajectory-dependent responses, with inflammatory peaks preceding organ-injury markers.</p>Conclusions<p>TTCS significantly reduced membership in high-risk lactate trajectory phenotypes. PE trajectory independently predicted in-hospital adverse outcomes and mirrored the postoperative inflammation–organ injury cascade.

A T2h lactate ≥2.45 mmol/L provides a practical early bedside risk-stratification tool.</p>