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Hemodilution on Cardiopulmonary Bypass as a Determinant of Early Postoperative Hyperlactatemia

OBJECTIVE: The nadir hematocrit (HCT) on cardiopulmonary bypass (CPB) is a recognized independent risk factor for major morbidity and mortality in cardiac surgery. The main interpretation is that low levels of HCT on CPB result in a poor oxygen delivery and dysoxia of end organs. Hyperlactatemia (HL...

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Autores principales: Ranucci, Marco, Carboni, Giovanni, Cotza, Mauro, Bianchi, Paolo, Di Dedda, Umberto, Aloisio, Tommaso
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Public Library of Science 2015
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4436314/
https://www.ncbi.nlm.nih.gov/pubmed/25992896
http://dx.doi.org/10.1371/journal.pone.0126939
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author Ranucci, Marco
Carboni, Giovanni
Cotza, Mauro
Bianchi, Paolo
Di Dedda, Umberto
Aloisio, Tommaso
author_facet Ranucci, Marco
Carboni, Giovanni
Cotza, Mauro
Bianchi, Paolo
Di Dedda, Umberto
Aloisio, Tommaso
author_sort Ranucci, Marco
collection PubMed
description OBJECTIVE: The nadir hematocrit (HCT) on cardiopulmonary bypass (CPB) is a recognized independent risk factor for major morbidity and mortality in cardiac surgery. The main interpretation is that low levels of HCT on CPB result in a poor oxygen delivery and dysoxia of end organs. Hyperlactatemia (HL) is a marker of dysoxic metabolism, and is associated with bad outcomes in cardiac surgery. This study explores the relationship between nadir HCT on CPB and early postoperative HL. DESIGN: Retrospective study on 3,851 consecutive patients. MEASUREMENTS AND MAIN RESULTS: Nadir HCT on CPB and other potential confounders were explored for association with blood lactate levels at the arrival in the Intensive Care Unit (ICU), and with the presence of moderate (2.1 – 6.0 mMol/L) or severe (> 6.0 mMol/L) HL. Nadir HCT on CPB demonstrated a significant negative association with blood lactate levels at the arrival in the ICU. After adjustment for the other confounders, the nadir HCT on CPB remained independently associated with moderate (odds ratio 0.96, 95% confidence interval 0.94-0.99) and severe HL (odds ratio 0.91, 95% confidence interval 0.86-0.97). Moderate and severe HL were significantly associated with increased morbidity and mortality. CONCLUSIONS: Hemodilution on CPB is an independent determinant of HL. This association, more evident for severe HL, strengthens the hypothesis that a poor oxygen delivery on CPB with consequent organ ischemia is the mechanism leading to hemodilution-associated bad outcomes.
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spelling pubmed-44363142015-05-27 Hemodilution on Cardiopulmonary Bypass as a Determinant of Early Postoperative Hyperlactatemia Ranucci, Marco Carboni, Giovanni Cotza, Mauro Bianchi, Paolo Di Dedda, Umberto Aloisio, Tommaso PLoS One Research Article OBJECTIVE: The nadir hematocrit (HCT) on cardiopulmonary bypass (CPB) is a recognized independent risk factor for major morbidity and mortality in cardiac surgery. The main interpretation is that low levels of HCT on CPB result in a poor oxygen delivery and dysoxia of end organs. Hyperlactatemia (HL) is a marker of dysoxic metabolism, and is associated with bad outcomes in cardiac surgery. This study explores the relationship between nadir HCT on CPB and early postoperative HL. DESIGN: Retrospective study on 3,851 consecutive patients. MEASUREMENTS AND MAIN RESULTS: Nadir HCT on CPB and other potential confounders were explored for association with blood lactate levels at the arrival in the Intensive Care Unit (ICU), and with the presence of moderate (2.1 – 6.0 mMol/L) or severe (> 6.0 mMol/L) HL. Nadir HCT on CPB demonstrated a significant negative association with blood lactate levels at the arrival in the ICU. After adjustment for the other confounders, the nadir HCT on CPB remained independently associated with moderate (odds ratio 0.96, 95% confidence interval 0.94-0.99) and severe HL (odds ratio 0.91, 95% confidence interval 0.86-0.97). Moderate and severe HL were significantly associated with increased morbidity and mortality. CONCLUSIONS: Hemodilution on CPB is an independent determinant of HL. This association, more evident for severe HL, strengthens the hypothesis that a poor oxygen delivery on CPB with consequent organ ischemia is the mechanism leading to hemodilution-associated bad outcomes. Public Library of Science 2015-05-18 /pmc/articles/PMC4436314/ /pubmed/25992896 http://dx.doi.org/10.1371/journal.pone.0126939 Text en © 2015 Ranucci et al http://creativecommons.org/licenses/by/4.0/ This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are properly credited.
spellingShingle Research Article
Ranucci, Marco
Carboni, Giovanni
Cotza, Mauro
Bianchi, Paolo
Di Dedda, Umberto
Aloisio, Tommaso
Hemodilution on Cardiopulmonary Bypass as a Determinant of Early Postoperative Hyperlactatemia
title Hemodilution on Cardiopulmonary Bypass as a Determinant of Early Postoperative Hyperlactatemia
title_full Hemodilution on Cardiopulmonary Bypass as a Determinant of Early Postoperative Hyperlactatemia
title_fullStr Hemodilution on Cardiopulmonary Bypass as a Determinant of Early Postoperative Hyperlactatemia
title_full_unstemmed Hemodilution on Cardiopulmonary Bypass as a Determinant of Early Postoperative Hyperlactatemia
title_short Hemodilution on Cardiopulmonary Bypass as a Determinant of Early Postoperative Hyperlactatemia
title_sort hemodilution on cardiopulmonary bypass as a determinant of early postoperative hyperlactatemia
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4436314/
https://www.ncbi.nlm.nih.gov/pubmed/25992896
http://dx.doi.org/10.1371/journal.pone.0126939
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