• Pedro Ferro Lima Menezes, Esper TremlRicardoRDepartment of Anesthesiology and Intensive Care Medicine, Friedrich-Schiller-University, Jena, Germany.Department of Anesthesiology, University of São Paulo, Sao Paulo, Brazil., Tulio Caldonazo, Hristo Kirov, da SilvaBruno CaldinBCDepartment of Critical care patients, Hospital Israelita Albert Einstein, São Paulo, SP, Brazil., de OliveiraAmanda Maria Ribas RosaAMRRDepartment of Anesthesiology Hospital do Câncer de Barretos, São Paulo, SP, Brazil., Cristina Prata Amendola, Fábio Barlem Hohmann, Sá MalbouissonLuiz MLMDepartment of Anesthesiology, University of São Paulo, Sao Paulo, Brazil., and João Manoel Silva.
• Department of Anesthesiology, University of São Paulo, Sao Paulo, Brazil.
• BMC Anesthesiol. 2024 Oct 9; 24 (1): 363363.

BackgroundPatients 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.ObjectiveCharacterize metabolic acidosis using delta-AG/delta-Bic and its associations in patients undergoing high-risk surgeries with possible outcome-related complications.DesignProspective observational multicentric study.SettingThree tertiary hospitals in Brazil.PatientsPatients undergoing high-risk surgeries, aged 18 years or older, requiring postoperative critical care.Main Outcome MeasuresPatients 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.ResultsFrom 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).ConclusionIn 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.© 2024. The Author(s).

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