Department of Anesthesiology, University of São Paulo, Sao Paulo, Brazil.
Department of Anesthesiology and Intensive Care Medicine, Friedrich-Schiller-University, Jena, Germany.
BMC Anesthesiol. 2024 Oct 9;24(1):363. doi: 10.1186/s12871-024-02564-z.
Patients undergoing high-risk surgeries with acid-based disorders are associated with poor outcomes. The screening of mixed acid-based metabolic disorders by calculating delta anion gap (AG)/delta bicarbonate (Bic) has a clinically relevant role in patients with high AG metabolic acidosis (MA), however its utility in individuals facing high-risk surgical procedures remains unclear.
Characterize metabolic acidosis using delta-AG/delta-Bic and its associations in patients undergoing high-risk surgeries with possible outcome-related complications.
Prospective observational multicentric study.
Three tertiary hospitals in Brazil.
Patients undergoing high-risk surgeries, aged 18 years or older, requiring postoperative critical care.
Patients undergoing high-risk surgeries monitored during the postoperative phase across three distinct intensive care units (ICUs), with assessment encompassing laboratory analyses upon admission and 24 h thereafter. Patients with MA and with elevated AG within 24 h were separated into 3 subgroups: [G1 - delta-AG/delta-Bic < 1.0] MA associated with hyperchloremia; [G2 - delta-AG/delta-Bic between 1.0 and 1.6] MA and no mixed disorders; and [G3 - delta-AG/delta-Bic > 1.6] MA associated with alkalosis. Primary endpoint was 30-day mortality. The secondary endpoints were cardiovascular, respiratory, renal, neurological, coagulation and infective complications.
From the 621 surgical patients admitted to ICU, 421 (51.7%) had any type of acidosis. After 24 h, 140 patients remained with MA with elevated AG (G1: 101, G2: 18, and G3: 21). When compared to patients from subgroups 1 and 3, the subgroup with no mixed disorders 2 showed higher 30-day mortality (adjusted HR = 3.72; 95% CI 1.11-12.89, p = 0.001), cardiovascular complications (p = 0.001), ICU mortality (p = 0.03) and sum of all complications during the ICU period (p = 0.021).
In the postoperative time, patients with metabolic acidosis and no mixed disorders present higher ICU-Mortality and higher cardiovascular postoperative complications when compared with patients with combined hyperchloremia or alkalosis. Delta-AG/delta-Bic can be a useful tool to evaluate major clinical outcomes in this population.
患有酸基紊乱的高危手术患者预后不良。通过计算阴离子间隙（AG）/碳酸氢盐（Bic）的差值（delta AG/delta Bic）来筛查混合酸基代谢紊乱，在高 AG 代谢性酸中毒（MA）患者中具有临床相关作用，但其在面临高风险手术的个体中的应用尚不清楚。
使用 delta-AG/delta-Bic 描述代谢性酸中毒，并描述其与可能与术后相关并发症相关的高危手术患者的关系。
前瞻性观察性多中心研究。
巴西的三家三级医院。
年龄在 18 岁或以上，接受高危手术，需要术后重症监护的患者。
在三个不同的重症监护病房（ICU）中对接受高危手术的患者进行术后监测，在入院时和 24 小时后进行实验室分析。在 24 小时内 MA 且 AG 升高的患者分为 3 个亚组：[G1 - delta-AG/delta-Bic < 1.0] MA 与高氯血症相关；[G2 - delta-AG/delta-Bic 在 1.0 和 1.6 之间] MA 且无混合紊乱；[G3 - delta-AG/delta-Bic > 1.6] MA 与碱中毒相关。主要终点是 30 天死亡率。次要终点是心血管、呼吸、肾脏、神经、凝血和感染并发症。
在入住 ICU 的 621 例手术患者中，有 421 例（51.7%）有任何类型的酸中毒。24 小时后，140 例患者仍有 MA 且 AG 升高（G1：101 例，G2：18 例，G3：21 例）。与第 1 和第 3 亚组相比，无混合紊乱的第 2 亚组 30 天死亡率更高（调整后的 HR = 3.72；95%CI 1.11-12.89，p = 0.001）、心血管并发症（p = 0.001）、ICU 死亡率（p = 0.03）和 ICU 期间所有并发症的总和（p = 0.021）。
在术后期间，与伴有混合性高氯血症或碱中毒的患者相比，代谢性酸中毒且无混合性紊乱的患者 ICU 死亡率和更高的心血管术后并发症更高。Delta-AG/delta-Bic 可作为评估该人群主要临床结局的有用工具。
