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

## TL;DR

This study found that lactic acidosis after heart surgery is linked to a higher risk of multiple organ failure and longer ICU stays.

## Contribution

The study establishes a novel association between post-CPB lactic acidosis and increased MODS incidence.

## Key findings

- Lactic acidosis was associated with higher MODS incidence (36%) compared to hyperlactatemia (14%) and normal controls (5%).
- Patients with lactic acidosis had significantly longer ICU stays than other groups.
- Lactic acidosis was identified as a risk factor for MODS after cardiopulmonary bypass.

## Abstract

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.

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.

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.

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