Association between lactic acidosis and multiple organ dysfunction syndrome after cardiopulmonary bypass

Dan Zheng; Guo-Liang Yu; Yi-Ping Zhou; Qiao-Min Zhang; Chun-Guo Wang; Sheng Zhang

doi:10.7717/peerj.16769

Association between lactic acidosis and multiple organ dysfunction syndrome after cardiopulmonary bypass

PeerJ. 2024 Jan 31:12:e16769. doi: 10.7717/peerj.16769. eCollection 2024.

Authors

Dan Zheng¹, Guo-Liang Yu¹, Yi-Ping Zhou¹, Qiao-Min Zhang¹, Chun-Guo Wang², Sheng Zhang¹

Affiliations

¹ Department of Critical Care Medicine, Taizhou Hospital of Zhejiang Province, Wenzhou Medical University, Linhai, China.
² Department of Cardiothoracic Surgery, Taizhou Hospital of Zhejiang Province, Wenzhou Medical University, Linhai, China.

Abstract

Background: The relationship between hyperlactatemia and prognosis after cardiopulmonary bypass (CPB) is controversial, and some studies ignore the presence of lactic acidosis in patients with severe hyperlactacemia. This study explored the association between lactic acidosis (LA) and the occurrence of multiple organ dysfunction syndrome (MODS) after cardiopulmonary bypass.

Methods: This study was a post hoc analysis of patients who underwent cardiac surgery between February 2017 and August 2018 and participated in a prospective study at Taizhou Hospital. The data were collected at: ICU admission (H0), and 4, 8, 12, 24, and 48 h after admission. Blood lactate levels gradually increased after CPB, peaking at H8 and then gradually decreasing. The patients were grouped as LA, hyperlactatemia (HL), and normal control (NC) based on blood test results 8 h after ICU admission. Basic preoperative, perioperative, and postoperative conditions were compared between the three groups, as well as postoperative perfusion and oxygen metabolism indexes.

Results: There were 22 (19%), 73 (64%), and 19 (17%) patients in the LA, HL, and NC groups, respectively. APACHE II (24h) and SOFA (24h) scores were the highest in the LA group (P < 0.05). ICU stay duration was the longest for the LA group (48.5 (42.5, 50) h), compared with the HL (27 (22, 48) h) and NC (27 (25, 46) h) groups (P = 0.012). The LA group had the highest incidence of MODS (36%), compared with the HL (14%) and NC (5%) groups (P = 0.015). In the LA group, the oxygen extraction ratio (O₂ER) was lower (21.5 (17.05, 32.8)%) than in the HL (31.3 (24.8, 37.6)%) and the NC group (31.3 (29.0, 35.4) %) (P = 0.018). In the univariable analyses, patient age (OR = 1.054, 95% CI [1.003-1.109], P = 0.038), the LA group (vs. the NC group, (OR = 10.286, 95% CI [1.148-92.185], P = 0.037), and ΔPCO2 at H8 (OR = 1.197, 95% CI [1.022-1.401], P = 0.025) were risk factor of MODS after CPB.

Conclusions: We speculated that there was correlation between lactic acidosis and MODS after CPB. In addition, LA should be monitored intensively after CPB.

Keywords: Acidosis; Cardiopulmonary bypass; Hyperlactatemia; Lactic; Multiple organ dysfunction syndrome.

MeSH terms

Acidosis, Lactic* / epidemiology
Cardiopulmonary Bypass / adverse effects
Humans
Hyperlactatemia* / epidemiology
Multiple Organ Failure / epidemiology
Oxygen
Postoperative Complications / epidemiology
Prospective Studies

Substances

Oxygen

Grants and funding

This study was supported by the Medical and Health Science and Technology Project of Zhejiang Province (2017KY163). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.