The Association Between Hypophosphatemia and Lactic Acidosis After Cardiac Surgery With Cardiopulmonary Bypass: A Retrospective Cohort Study
The clinical significance of hypophosphatemia in cardiac surgery has not been investigated extensively. The aim of this study was to evaluate the association of postoperative hypophosphatemia and lactic acidosis in cardiac surgery patients at the time of intensive care unit (ICU) admission. A retros...
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Published in | Journal of cardiothoracic and vascular anesthesia Vol. 37; no. 3; pp. 374 - 381 |
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Main Authors | , , , , , , , , |
Format | Journal Article |
Language | English |
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Elsevier Inc
01.03.2023
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Abstract | The clinical significance of hypophosphatemia in cardiac surgery has not been investigated extensively. The aim of this study was to evaluate the association of postoperative hypophosphatemia and lactic acidosis in cardiac surgery patients at the time of intensive care unit (ICU) admission.
A retrospective cohort study.
At a single academic center.
Patients who underwent nontransplant cardiac surgery with cardiopulmonary bypass between August 2009 and December 2020.
None.
Serum phosphate and lactate levels were measured upon ICU admission in patients undergoing nontransplant cardiac surgery with cardiopulmonary bypass. There were 681 patients in the low-phosphate (<2.5 mg/dL) group and 2,579 patients in the normal phosphate group (2.5-4.5 mg/dL). A higher proportion of patients in the low phosphate group (26%; 179 of 681; 95% CI: 23-30) had severe lactic acidosis compared to patients in the normal phosphate group (16%; 417 of 2,579; 95% CI: 15-18). In an unadjusted logistic regression model, patients in the low phosphate group had 1.9-times the odds of having severe lactic acidosis (serum lactate ≥4.0 mmol/L) when compared to patients in the normal phosphate group (95% CI: 1.5-2.3), and still 1.4-times the odds (95% CI: 1.1-1.7) after adjusting for several possible confounders.
Hypophosphatemia is associated with lactic acidosis in the immediate postoperative period in cardiac surgery patients. Future studies will need to investigate it as a potential treatment target for lactic acidosis. |
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AbstractList | The clinical significance of hypophosphatemia in cardiac surgery has not been investigated extensively. The aim of this study was to evaluate the association of postoperative hypophosphatemia and lactic acidosis in cardiac surgery patients at the time of intensive care unit (ICU) admission.
A retrospective cohort study.
At a single academic center.
Patients who underwent nontransplant cardiac surgery with cardiopulmonary bypass between August 2009 and December 2020.
None.
Serum phosphate and lactate levels were measured upon ICU admission in patients undergoing nontransplant cardiac surgery with cardiopulmonary bypass. There were 681 patients in the low-phosphate (<2.5 mg/dL) group and 2,579 patients in the normal phosphate group (2.5-4.5 mg/dL). A higher proportion of patients in the low phosphate group (26%; 179 of 681; 95% CI: 23-30) had severe lactic acidosis compared to patients in the normal phosphate group (16%; 417 of 2,579; 95% CI: 15-18). In an unadjusted logistic regression model, patients in the low phosphate group had 1.9-times the odds of having severe lactic acidosis (serum lactate ≥4.0 mmol/L) when compared to patients in the normal phosphate group (95% CI: 1.5-2.3), and still 1.4-times the odds (95% CI: 1.1-1.7) after adjusting for several possible confounders.
Hypophosphatemia is associated with lactic acidosis in the immediate postoperative period in cardiac surgery patients. Future studies will need to investigate it as a potential treatment target for lactic acidosis. OBJECTIVESThe clinical significance of hypophosphatemia in cardiac surgery has not been investigated extensively. The aim of this study was to evaluate the association of postoperative hypophosphatemia and lactic acidosis in cardiac surgery patients at the time of intensive care unit (ICU) admission.DESIGNA retrospective cohort study.SETTINGAt a single academic center.PARTICIPANTSPatients who underwent nontransplant cardiac surgery with cardiopulmonary bypass between August 2009 and December 2020.INTERVENTIONSNone.MEASUREMENTS AND MAIN RESULTSSerum phosphate and lactate levels were measured upon ICU admission in patients undergoing nontransplant cardiac surgery with cardiopulmonary bypass. There were 681 patients in the low-phosphate (<2.5 mg/dL) group and 2,579 patients in the normal phosphate group (2.5-4.5 mg/dL). A higher proportion of patients in the low phosphate group (26%; 179 of 681; 95% CI: 23-30) had severe lactic acidosis compared to patients in the normal phosphate group (16%; 417 of 2,579; 95% CI: 15-18). In an unadjusted logistic regression model, patients in the low phosphate group had 1.9-times the odds of having severe lactic acidosis (serum lactate ≥4.0 mmol/L) when compared to patients in the normal phosphate group (95% CI: 1.5-2.3), and still 1.4-times the odds (95% CI: 1.1-1.7) after adjusting for several possible confounders.CONCLUSIONSHypophosphatemia is associated with lactic acidosis in the immediate postoperative period in cardiac surgery patients. Future studies will need to investigate it as a potential treatment target for lactic acidosis. |
Author | Fong, Christine T. Cain, Kevin C. Sheu, Richard D. Mostofi, Nicki Wu, David Togashi, Kei Jelacic, Srdjan Steck, Dominik T. Wells, Lauren |
Author_xml | – sequence: 1 givenname: Dominik T. surname: Steck fullname: Steck, Dominik T. email: dsteck@uw.edu organization: Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, WA – sequence: 2 givenname: Srdjan orcidid: 0000-0002-6617-9870 surname: Jelacic fullname: Jelacic, Srdjan organization: Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, WA – sequence: 3 givenname: Nicki orcidid: 0000-0001-9519-6074 surname: Mostofi fullname: Mostofi, Nicki organization: Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, WA – sequence: 4 givenname: David orcidid: 0000-0002-5441-1943 surname: Wu fullname: Wu, David organization: Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University, Stanford, CA – sequence: 5 givenname: Lauren surname: Wells fullname: Wells, Lauren organization: Section of Emergency Medicine, University of Chicago, Chicago, IL – sequence: 6 givenname: Christine T. surname: Fong fullname: Fong, Christine T. organization: Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, WA – sequence: 7 givenname: Kevin C. surname: Cain fullname: Cain, Kevin C. organization: Office of Nursing Research and Department of Biostatistics, University of Washington, Seattle, WA – sequence: 8 givenname: Richard D. orcidid: 0000-0003-0198-012X surname: Sheu fullname: Sheu, Richard D. organization: Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, WA – sequence: 9 givenname: Kei surname: Togashi fullname: Togashi, Kei organization: Department of Anesthesiology and Perioperative Care, University of California, Irvine, Orange, CA |
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Keywords | phosphate lactic acidosis cardiopulmonary bypass insulin lactate hypophosphatemia |
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Snippet | The clinical significance of hypophosphatemia in cardiac surgery has not been investigated extensively. The aim of this study was to evaluate the association... OBJECTIVESThe clinical significance of hypophosphatemia in cardiac surgery has not been investigated extensively. The aim of this study was to evaluate the... |
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SubjectTerms | Acidosis, Lactic - diagnosis Acidosis, Lactic - epidemiology Acidosis, Lactic - etiology Cardiac Surgical Procedures - adverse effects cardiopulmonary bypass Cardiopulmonary Bypass - adverse effects Humans hypophosphatemia Hypophosphatemia - diagnosis Hypophosphatemia - epidemiology Hypophosphatemia - etiology insulin lactate Lactates lactic acidosis phosphate Phosphates Retrospective Studies |
Title | The Association Between Hypophosphatemia and Lactic Acidosis After Cardiac Surgery With Cardiopulmonary Bypass: A Retrospective Cohort Study |
URI | https://dx.doi.org/10.1053/j.jvca.2022.11.032 https://www.ncbi.nlm.nih.gov/pubmed/36528501 https://search.proquest.com/docview/2755580809 |
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