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Red blood cell transfusion affects microdialysis-assessed interstitial lactate/pyruvate ratio in critically ill patients with late sepsis

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Abstract

Purpose

The aim of this study was to explore the effect of red blood cell (RBC) transfusion on microdialysis-assessed interstitial fluid metabolic parameters in septic patients.

Methods

We conducted a retrospective study of 37 patients with severe sepsis/septic shock requiring transfusion of one to two RBC units. Interstitial fluid metabolic alterations were monitored by a microdialysis catheter inserted in the subcutaneous adipose tissue. Samples were collected before (T0) and after transfusion at two time-points: T1a and T1b; median post-transfusion times of 120 [interquartile range (IQR); 45–180] and 360 (IQR; 285–320) min. Lactate, pyruvate, glycerol and glucose concentrations were measured with a bedside analyzer, and the lactate/pyruvate (LP) ratio was calculated automatically.

Results

RBC transfusions decreased the LP ratio from (T0) 18.80 [interquartile range (IQR); 14.85–27.45] to (T1a) 17.80 (IQR; 14.35–25.20; P < 0.05) and (T1b) 17.90 (IQR; 14.45–22.75; P < 0.001), while there was also significant interindividual variation. Post-transfusion LP ratio changes at T1a [r = −0.42; 95 % confidence interval (CI), −0.66 to −0.098; P = 0.01] and T1b (r = −0.68; 95 % [CI], −0.82 to −0.44; P < 0.001) were significantly correlated with the pre-transfusion LP ratio, but not with baseline demographic characteristics, vital signs, severity scores, hemoglobin level and blood lactate. RBC storage time and leukocyte reduction had no influence on the tissue metabolic response to transfusion.

Conclusions

Tissue oxygenation is affected by RBC transfusion in critically ill septic patients. Monitoring of tissue LP ratio by microdialysis may represent a useful method for individual clinical management.

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Acknowledgments

We gratefully acknowledge the contribution of the medical and nursing staff of the Second Department of Critical Care Medicine in “Attiko” University Hospital to the completion of this study. We also wish to recognize the technical expertise of Argyrios Diamantakis, RN, who dedicated long hours to helping us in this research project.

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Authors and Affiliations

  1. Second Department of Critical Care Medicine, “Attiko” University Hospital, Medical School, National and Kapodistrian University of Athens, 1 Rimini Street, Haidari, 12462, Athens, Greece

    Petros Kopterides, Maria Theodorakopoulou, Nikitas Nikitas, Stylianos E. Orfanos, Iraklis Tsangaris, Nikolaos A. Maniatis, Apostolos Armaganidis & Ioanna Dimopoulou

  2. Department of Endocrinology, “Elena” Hospital, Athens, Greece

    Ioannis Ilias

  3. Second Department of Internal Medicine, “Attiko” University Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece

    Dimitra Argiro Vassiliadi & George Dimitriadis

  4. Laboratory of Hematology and Blood Bank Unit, “Attiko” University Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece

    Argirios E. Tsantes & Anthi Travlou

  5. Department of Physiology and Pharmacology, Karolinska Institute, Stockholm, Sweden

    Urban Ungerstedt

Authors
  1. Petros Kopterides
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  2. Maria Theodorakopoulou
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  6. Stylianos E. Orfanos
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  8. Nikolaos A. Maniatis
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  14. Ioanna Dimopoulou
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Correspondence to Petros Kopterides.

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Kopterides, P., Theodorakopoulou, M., Nikitas, N. et al. Red blood cell transfusion affects microdialysis-assessed interstitial lactate/pyruvate ratio in critically ill patients with late sepsis. Intensive Care Med 38, 1843–1850 (2012). https://doi.org/10.1007/s00134-012-2635-8

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