Zhou Xiao-Fen, Chen Han, Ke Jun, Lin Shi-Rong, Huang Ting-Feng, Chen Bing-Ying, Jiang Xin-Da, Chen Feng
Shengli Clinical Medical College of Fujian Medical University, Fuzhou, Fujian, China.
The Fourth Department of Critical Care Medicine, Fuzhou University Affiliated Provincial Hospital, Fuzhou, Fujian, China.
Front Cardiovasc Med. 2025 Apr 11;12:1504431. doi: 10.3389/fcvm.2025.1504431. eCollection 2025.
This study aimed to compare the performance of lactate and CO-derived parameters in predicting major postoperative complications (MPC) after cardiac surgery with cardiopulmonary bypass.
Lactate and CO-derived parameters, including the venous-arterial difference in CO partial pressure (Pv-aCO), the venous-arterial difference in CO partial pressure to arterial-venous O content ratio (Pv-aCO/Ca-vO), and the venous-arterial difference in CO content to arterial-venous O content ratio (Cv-aCO/Ca-vO) at ICU admission, 3 h, 6 h, and 12 h later were collected. Receiver-operating characteristics (ROC) curve analysis was carried out to assess the predictive performance. Univariate and multivariate logistic regression analyses were performed to identify independent predictors of MPC.
MPC occurred in 77 (54.2%) of 142 patients. No significant difference was observed between the MPC and no-MPC groups regarding lactate and CO-derived parameters. The area under the curves (AUCs) were 0.532 (0.446-0.616) for lactate, 0.559 (0.473-0.642) for Pv-aCO, 0.617 (0.532-0.697) for Pv-aCO/Ca-vO, and 0.625 (0.540-0.705) for Cv-aCO/Ca-vO, respectively, and there was no significant difference between the parameters. In the analysis, all parameters' AUCs were lower than 0.75 in predicting acute renal failure, and there was no significant difference between these parameters. Cv-aCO/Ca-vO at 12 h yielded the highest AUC of 0.853 (0.784-0.907) in predicting mortality and the highest AUC of 0.808 (0.733-0.869) in predicting delirium. In multivariate analysis, hypertension, surgery duration, and PaO/FiO were identified as independent predictors of MPC, while lactate and CO-derived parameters lost statistical significance after adjustment for covariates.
Lactate and CO-derived parameters cannot be used as reliable indicators to predict the occurrence of MPC after cardiopulmonary bypass. Instead, traditional clinical factors such as hypertension, extended surgical duration, and impaired oxygenation emerged as the most reliable risk indicators.
本研究旨在比较乳酸和基于心输出量（CO）的参数在预测体外循环心脏手术后主要术后并发症（MPC）方面的性能。
收集入住重症监护病房（ICU）时、3小时、6小时和12小时后的乳酸和基于CO的参数，包括CO分压的动静脉差值（Pv-aCO）、CO分压与动静脉氧含量比的动静脉差值（Pv-aCO/Ca-vO）以及CO含量与动静脉氧含量比的动静脉差值（Cv-aCO/Ca-vO）。进行受试者操作特征（ROC）曲线分析以评估预测性能。进行单因素和多因素逻辑回归分析以确定MPC的独立预测因素。
142例患者中有77例（54.2%）发生MPC。在MPC组和非MPC组之间，乳酸和基于CO的参数未观察到显著差异。乳酸的曲线下面积（AUC）为0.532（0.446 - 0.616），Pv-aCO为0.559（0.473 - 0.642），Pv-aCO/Ca-vO为0.617（0.532 - 0.697），Cv-aCO/Ca-vO为0.625（0.540 - 0.705），各参数之间无显著差异。在预测急性肾衰竭的分析中，所有参数的AUC均低于0.75，这些参数之间无显著差异。12小时时的Cv-aCO/Ca-vO在预测死亡率方面的AUC最高，为0.853（0.784 - 0.907），在预测谵妄方面的AUC最高，为0.808（0.733 - 0.869）。在多因素分析中，高血压、手术时间和PaO/FiO被确定为MPC的独立预测因素，而在调整协变量后，乳酸和基于CO的参数失去统计学意义。
乳酸和基于CO的参数不能用作预测体外循环后MPC发生的可靠指标。相反，高血压、手术时间延长和氧合受损等传统临床因素是最可靠的风险指标。
