The Relationship Between Lactate Dehydrogenase/Albumin Ratio as a Molecular Indicator of Cellular Stress and Perfusion Dynamics in Cardiopulmonary Bypass Patients

Öz

Aim: Cardiopulmonary bypass (CPB) is a complex process characterised by ischaemia-reperfusion injury, systemic inflammation, and metabolic reprogramming. Evaluating the cellular stress that develops during this process at the molecular level in the early stages may contribute to a better understanding of perfusion disorders. Lactate dehydrogenase (LDH) is an indicator of cellular damage and metabolic stress, while albumin is associated with antioxidant capacity and modulation of the inflammatory response. The LDH/albumin ratio stands out as a composite molecular indicator that holistically reflects these two parameters. The aim of this study is to evaluate the relationship between the LDH/albumin ratio, which is considered a composite molecular marker of cellular stress in patients undergoing CPB, and the metabolic response reflecting perfusion dynamics and tissue hypoperfusion. Methods: This retrospective study included 125 adult patients who underwent cardiac surgery with cardiopulmonary bypass between January 2024 and January 2025. Preoperative and postoperative LDH, albumin levels, and LDH/albumin ratios were recorded. Perfusion-related variables and perioperative lactate levels were analysed; correlations between the LDH/albumin ratio and these parameters were evaluated using correlation analyses. Results: The mean preoperative LDH/albumin ratio was 41.24 ± 12.27, while it increased to 139.81 ± 47.86 in the postoperative period. A significant positive correlation was found between the preoperative LDH/Albumin ratio and postoperative lactate levels (r = 0.206; p = 0.021). The relationship between the postoperative LDH/Albumin ratio and postoperative lactate levels was found to be stronger (r = 0.293; p = 0.001). No significant relationship was observed between the LDH/Albumin ratio and aortic cross-clamp time, total perfusion time, intensive care unit stay, or hospital stay. Conclusion: The LDH/albumin ratio shows a significant correlation with postoperative lactate levels as a molecular reflection of perfusion-related metabolic stress in patients undergoing CPB. Based on routine biochemical parameters, this ratio can be considered a practical molecular biomarker that complements perfusion data in the assessment of cellular stress and tissue hypoperfusion during the CPB process.

Anahtar Kelimeler

• cardiopulmonary bypass
• cellular stress
• metabolic stress
• lactate dehydrogenase
• albumin
• LDH/albumin ratio

Kardiyopulmoner Bypass Hastalarında Hücresel Stresin Moleküler Bir Göstergesi Olarak Laktat Dehidrogenaz/Albumin Oranının Perfüzyon Dinamikleri ile İlişkisi

Öz

Giriş: Kardiyopulmoner bypass (KPB), iskemi-reperfüzyon hasarı, sistemik inflamasyon ve metabolik yeniden programlanma ile karakterize kompleks bir süreçtir. Bu süreçte gelişen hücresel stresin erken dönemde moleküler düzeyde değerlendirilmesi, perfüzyon bozukluklarının daha iyi anlaşılmasına katkı sağlayabilir. Laktat dehidrogenaz (LDH) hücresel hasar ve metabolik stresin bir göstergesi iken, albümin antioksidan kapasitesi ve inflamatuar yanıtın modülasyonu ile ilişkilidir. LDH/albümin oranı, bu iki parametreyi bütüncül biçimde yansıtan bileşik bir moleküler gösterge olarak öne çıkmaktadır. Bu çalışmanın amacı, KPB uygulanan hastalarda hücresel stresin bileşik bir moleküler göstergesi olarak değerlendirilen LDH/albumin oranı ile perfüzyon dinamikleri ve doku hipoperfüzyonunu yansıtan metabolik yanıt arasındaki ilişkiyi değerlendirmektir. Gereç ve Yöntemler: Bu retrospektif çalışmaya, Ocak 2024–Ocak 2025 tarihleri arasında KPB eşliğinde kalp cerrahisi uygulanan 125 erişkin hasta dahil edilmiştir. Preoperatif ve postoperatif LDH, albümin düzeyleri ve LDH/albümin oranları kaydedilmiştir. Perfüzyonla ilişkili değişkenler ve perioperatif laktat düzeyleri analiz edilmiş; LDH/albümin oranı ile bu parametreler arasındaki ilişkiler korelasyon analizleri ile değerlendirilmiştir. Bulgular: Ortalama preoperatif LDH/albümin oranı 41,24 ± 12,27 iken, postoperatif dönemde 139,81 ± 47,86’ya yükselmiştir. Preoperatif LDH/albümin oranı ile postoperatif laktat düzeyleri arasında anlamlı pozitif bir korelasyon saptanmıştır (r = 0,206; p = 0,021). Postoperatif LDH/albümin oranı ile postoperatif laktat düzeyleri arasındaki ilişki daha güçlü bulunmuştur (r = 0,293; p = 0,001). LDH/albümin oranı ile aortik kros klemp süresi, toplam perfüzyon süresi, yoğun bakım ve hastanede kalış süreleri arasında anlamlı bir ilişki izlenmemiştir. Sonuç: LDH/albümin oranı, KPB uygulanan hastalarda perfüzyonla ilişkili metabolik stresin moleküler bir yansıması olarak postoperatif laktat düzeyleri ile anlamlı ilişki göstermektedir. Rutin biyokimyasal parametrelere dayanan bu oran, KPB sürecinde hücresel stresin ve doku hipoperfüzyonunun değerlendirilmesinde perfüzyon verilerini tamamlayıcı, pratik bir moleküler biyobelirteç olarak değerlendirilebilir.

Anahtar Kelimeler

• kardiyopulmoner bypass
• hücresel stres
• metabolik stres
• laktat dehidrojenaz
• albümin
• LDH/albümin oranı.

Kaynakça

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