Evaluation of Postoperative Acid-Base Balance and Lactate Levels as Predictors of ICU Length of Stay in Liver Transplant Patients

Abstract

Purpose: Liver transplantation is a life-saving procedure for patients with end-stage liver disease. The postoperative period presents significant challenges, particularly in managing acid-base balance and lactate levels, which are crucial indicators of metabolic stability and tissue perfusion. While these parameters provide valuable insights into patient recovery, their role in predicting intensive care unit (ICU) length of stay remains unclear. This study evaluates whether early postoperative acid-base balance and lactate levels can reliably predict ICU length of stay in liver transplant recipients, aiming to enhance postoperative care strategies. Methods: A retrospective observational study was conducted on 53 adult liver transplant recipients. Acid-base and lactate parameters were measured at two-time points: early (within the first 6 hours) and late (6-24 hours) postoperatively. Paired t-tests and Wilcoxon signed-rank tests were used to compare these measurements. Multiple linear regression modeling was employed to assess the impact of these parameters on ICU length of stay. Results: Significant changes were observed in FiO<inf>2</inf>, pH, Base Excess, HCO<inf>3</inf>, lactate, and Strong Ion Difference (SID) between early and late postoperative measurements (P < .05). However, regression analysis revealed that maximum lactate and early SID were not strong predictors of ICU length of stay (R² = 0.062). Exploratory analyses indicated that patients with elevated SID and markedly high lactate levels tended to have prolonged ICU stays. Conclusions: While postoperative acid-base balance and lactate levels are important indicators of physiological status in liver transplant recipients, they do not serve as strong independent predictors of ICU length of stay. © 2025 Elsevier B.V., All rights reserved.