Increased lactate and decreased pH levels in VBG associated with disease severity in liver disease patients: Study
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A new study published in the journal of Cureus showed that venous blood gas (VBG) analysis has shown itself to be a safe and accurate predictive technique for chronic liver disease (CLD) as an alternative to arterial sampling.
The prognosis of patients with chronic liver disease is greatly impacted by systemic consequences like acid-base abnormalities. Traditionally, arterial blood gas (ABG) analysis has been used to track these disruptions, but it has procedural hazards, particularly for patients with coagulopathies, a well-known consequence of CLD.
Thus, this study by Manish Bansal and team assessed the predictive value of venous blood gas characteristics in individuals with chronic liver disease. The goals of this study were to evaluate VBG values in patients with CLD, use the Child-Turcotte-Pugh (CTP) score to correlate these parameters with the severity of the disease, and ascertain how predictive these data were of patient outcomes and death.
From November 2022 to January 2025, 253 individuals with CLD were included in a hospital-based observational cross-sectional research at S. N. Medical College in Agra. Upon admission, VBG parameters were examined, including pH, pCO₂, bicarbonate (HCO₃⁻), base excess, and serum lactate. The CTP score was used to categorize clinical severity, and outcomes such as complications, hospitalization, and death were examined. Using SPSS version 26 (IBM Corp., Armonk, NY, USA), descriptive and inferential statistical techniques were used for data analysis.
The most prevalent cause among participants (47.8%) was alcohol-related liver disease, while 63.24% of participants were male. VBG values varied significantly between CTP classes; CTP Class C had higher lactate (4.9±1.7 mmol/L) and lower pH (7.21±0.09) and bicarbonate (16.3±4.1 mmol/L) (p<0.001).
Lactate levels and CTP scores showed strong associations (r=0.82, p<0.001). The strongest independent predictor of death was elevated lactate (>4.5 mmol/L) (adjusted HR=7.1). Increased lactate and deteriorating CTP class were associated with significantly worse 30-day survival rates, according to Kaplan-Meier analysis (p<0.001).
Overall, in patients with CLD, VBG parameters (high lactate and lowered pH) offer vital prognostic information and have a substantial correlation with the severity and mortality of the disease. VBG analysis provides a safer, more dependable, and more useful substitute for arterial blood gas analysis in ordinary clinical practice, improving risk classification and treatment of hospitalized CLD patients.
Source:
Bansal, M. K., Mishra, V., Singhal, R., Sharma, M., Prakash, C., & Rawat, S. (2025). Venous blood gas (VBG) analysis is as safe and equally reliable as arterial blood gas (ABG) analysis in the determination of prognosis in chronic liver disease patients: A study conducted in a tertiary care hospital in Uttar pradesh, India. Cureus, 17(6). https://doi.org/10.7759/cureus.86977
