Key result
Elevated venous-to-arterial pCO2 gap during CPB is not associated with AKI versus low gap.
Why the study?
Although acute kidney injury is linked to oxygen consumption and delivery mismatch during CPB, the prognostic value of central venous-to-arterial pCO2 gap during CPB to predict CSA-AKI remained to be explored.
Does an elevated venous-to-arterial pCO2 gap during cardiopulmonary bypass predict cardiac surgery-associated acute kidney injury?
Cohort (n=318)
Yes
Does an elevated venous-to-arterial pCO2 gap during cardiopulmonary bypass predict cardiac surgery-associated acute kidney injury?
Absolute Event Rate: 23.8% vs 32.4%
p-value: p=0.14
A single intraoperative measurement of venous-to-arterial pCO2 gap during cardiopulmonary bypass is not a reliable predictor of cardiac surgery-associated acute kidney injury.
Cardiac surgery-associated acute kidney injury (CSA-AKI) is one of the most frequent and severe complications after cardiac surgery. The association between acute kidney injury and the mismatch between oxygen consumption and delivery has been well established during cardiopulmonary bypass (CPB). In this study, we aim to explore the prognostic value of the central venous-to-arterial pCO 2 gap during CPB to predict CSA-AKI. Bicentric retrospective study conducted in two teaching hospitals. All patients who underwent cardiac surgery requiring CPB in two periods between 2019 and 2023 were screened for inclusion. Patients were divided into 2 groups according to the presence or absence of an elevated pCO 2 gap during CPB, which was defined as greater than 6 mmHg. The primary outcome was the occurrence of CSA-AKI. Among 318 patients included, 213 were in the low pCO 2 gap group and 105 in the elevated pCO 2 gap group. No significant difference in CSA-AKI occurrence was found between groups (32.4% vs. 23.8%; p = 0.14). pCO 2 gap was not a good predictor of CSA-AKI, with an area under the curve for the ROC curve of 0.63 (p = 0.87). Except for SVO 2 during CPB, we did not find any correlation between pCO 2 gap and other tissue perfusion parameters during or after CPB. We did not find any association between the presence of an elevated pCO 2 gap during CPB and the occurrence of CSA-AKI. This may suggest that a single intraoperative measurement of pCO₂ gap is not a reliable marker of persistent tissue hypoperfusion in this context
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Jeanmougin et al. (2025) conducted a cohort in Cardiac surgery-associated acute kidney injury (CSA-AKI) (n=318). Elevated central venous-to-arterial pCO2 gap (>6 mmHg) vs. Low pCO2 gap (≤6 mmHg) was evaluated on Occurrence of CSA-AKI (p=0.14). An elevated venous-to-arterial pCO2 gap (>6 mmHg) during cardiopulmonary bypass was not associated with acute kidney injury compared to a low gap (23.8% vs 32.4%; p=0.14).
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