Negative alactic base excess is reversed by hemoperfusion in septic patients

Introduction: Gattinoni et al. have recently introduced a new parameter: the “alactic base excess” (ABE). ABE is equivalent to the number of strong acids, other than lactate, which are present in the plasma in abnormal concentrations, negative ABE being associated with higher mortality in sepsis. Hemoperfusion (HPF) is an extracorporeal procedure that involves the passage of blood through an adsorption cartridge, where solutes are removed by direct binding to the sorbent material. Then, it was decided to explore the influence of HPF on negative ABE value in sepsis.
Materials and methods: Basal values of ABE, standard base excess (SBE), and lactate (mean, standard deviation [SD]) were obtained. The difference between these parameter values before and after four sessions of HPF (HA330) (delta value) was evaluated. Student’s t-test and Wilcoxon test were applied.
Results: From 32 patients (age: 57±13) suffering from respiratory insufficiency secondary to COVID-19 who were treated with HPF in the critical care unit of Clinica de la Mujer, Bogotá (Colombia), 6 patients presented with metabolic acidosis with negative ABE value (‒2.7±1) with negative SBE (‒4.7±1) and high lactate serum value (2±0.7 mmol/L). Delta ABE, SBE, and lactate were: 7.7 (p = 0.005), 6.1 (p = 0.003), and 1.6 (p = NS), respectively. Thus, negative ABE was significantly reversed by HPF, since SBE value turned positive without significant change in lactate.
Conclusion: Negative alactic parameter was significantly reversed by HPF in septic patients. It is necessary to carry out evaluations in larger groups to estimate their impact on clinical outcomes.