Key result
Post-CPB lactate-leukocyte product >72 strongly predicts early complications after prolonged bypass.
Why the study?
Complications related to cardiopulmonary bypass (CPB) remain an urgent problem in cardiac surgery, prompting the need for an algorithm to predict CPB complications based on bypass duration and laboratory monitoring data.
Does the post-perfusion product of blood lactate and leukocyte levels predict early postoperative complications in patients undergoing elective cardiac surgery with prolonged cardiopulmonary bypass (≥ 132 minutes)?
Cohort (n=150)
No
Does the post-perfusion product of blood lactate and leukocyte levels predict early postoperative complications in patients undergoing elective cardiac surgery with prolonged cardiopulmonary bypass (≥ 132 minutes)?
Answers are grounded in this paper and cite their sources.
In cardiac surgery patients with prolonged cardiopulmonary bypass (≥ 132 minutes), a simple post-perfusion product of blood lactate and leukocyte count > 72 units accurately identifies patients at high risk for severe early postoperative complications and prolonged mechanical ventilation.
INTRODUCTION: Complications related to cardiopulmonary bypass (CPB) remain an urgent problem in cardiac surgery. OBJECTIVE: To develop an algorithm for predicting CPB complications based on its duration and laboratory monitoring data. MATERIALS AND METHODS: A retrospective analysis of 150 patients (86 men, 64 women) aged 65 ± 7 years who underwent elective surgery with CPB was performed. Biomarkers and blood circulation parameters were determined before incision and after CPB. The postoperative period was considered complicated in the presence of a combined endpoint: death, mechanical ventilation > 12 h, renal replacement therapy (RRT), acute encephalopathy, or non-drug depression of consciousness. RESULTS: The combined primary endpoint was registered in 34 (22.7 %) patients. The threshold value of CPB duration associated with complications was 132 min (AUC 0.734; sensitivity 52 %, specificity 93 %; p < 0.0001). In patients with CPB ≥ 132 min (n = 35), CPB duration lost prognostic significance; however, lactate and leukocyte levels after CPB differed significantly between patients with complicated and uncomplicated courses. Their combination in a logistic regression model provided high prognostic efficacy (AUC 0.936). For practical use, an integral index — the product of lactate and leukocytes after CPB — was proposed. A threshold value > 72 units predicted the combined primary endpoint with a sensitivity of 100 % and specificity of 81 % (AUC 0.909). In patients with an index > 72 units, mechanical ventilation was significantly longer (55 ± 10 vs 11 ± 2 h; log-rank p < 0.0001). CONCLUSIONS: CPB duration exceeding 132 min is a significant but insufficient factor for individual prognosis. In patients with prolonged CPB, the post-perfusion product of lactate level and leukocyte count is of decisive prognostic value and may be used for early risk stratification.
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Rybakov et al. (2026) conducted a cohort in Elective cardiac surgery with cardiopulmonary bypass (CPB) (n=150). Prolonged cardiopulmonary bypass (CPB ≥ 132 min) and post-CPB lactate × leukocyte product (> 72 units) vs. Shorter CPB duration (< 132 min) or lower post-CPB lactate × leukocyte product (≤ 72 units) was evaluated on Combined endpoint of early postoperative complications (death, mechanical ventilation > 12 h, renal replacement therapy, acute encephalopathy, non-drug depression of consciousness, or norepinephrine support > 24 h) (p=<0.05). Post-CPB lactate-leukocyte product >72 units predicted early postoperative complications in patients with CPB ≥132 min with 100% sensitivity and 81% specificity.
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