Jin Hee Kim1, Dong-Hyun Jang2, You Hwan Jo3, Gil Joon Suh4, Woon Yong Kwon4, Jae Hyuk Lee1, Jonghwan Shin5, Inwon Park1, Che Uk Lee1, Sang-Min Lee1. 1. Department of Emergency Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea. 2. Department of Emergency Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea. Electronic address: jang0621@snubh.org. 3. Department of Emergency Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea; Department of Emergency Medicine, Seoul National University, College of Medicine, Seoul, Republic of Korea. Electronic address: emdrjyh@gmail.com. 4. Department of Emergency Medicine, Seoul National University, College of Medicine, Seoul, Republic of Korea; Department of Emergency Medicine, Seoul National University Hospital, Seoul, Republic of Korea. 5. Department of Emergency Medicine, Seoul National University, College of Medicine, Seoul, Republic of Korea; Department of Emergency Medicine, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul, Republic of Korea.
Abstract
OBJECTIVE: Metabolic acidosis is commonly associated with the disease severity in patients with sepsis or septic shock. This study was performed to investigate the association between serum total carbon dioxide (TCO2) concentration and 28-day mortality in patients with sepsis. METHODS: This study was a multicenter retrospective cohort study of patients with sepsis or septic shock. The relationships between serum TCO2 and 28-day mortality, bicarbonate, pH, lactate, and anion gap were determined with cubic spline curves. The patients were divided into four groups according to their serum TCO2 concentration: Group I (TCO2 > 20 mmol/l), Group II (15 < TCO2 ≤ 20 mg/dl), Group III (10 < TCO2 ≤ 15 mmol/l), and Group IV (TCO2 ≤ 10 mmol/l). RESULTS: A total of 3168 patients were included in the analysis, and the overall mortality rate was 24.1%. Serum TCO2 concentrations below 20 mmol/l showed an almost linear correlation with mortality as well as with lactate, bicarbonate, and pH. The 28-day mortality rates of Group I, II, III, and IV were 18.3%, 23.6%, 32.6%, and 50.0%, respectively (p < .001). In Multivariable Cox proportional hazard regression analysis, the groups with lower serum TCO2 concentrations had a higher risk of 28-day mortality compared with Group I: Group II (Hazard ratio (HR), 1.35; 95% confidence interval (CI), 1.11-1.64), Group III (HR, 1.74; 95% CI, 1.37-2.21), and Group IV (HR, 2.72; 95% CI, 2.03-3.64). CONCLUSIONS: Serum TCO2 concentrations of 20 mmol/l or less were associated with 28-day mortality in patients with sepsis.
OBJECTIVE:Metabolic acidosis is commonly associated with the disease severity in patients with sepsis or septic shock. This study was performed to investigate the association between serum total carbon dioxide (TCO2) concentration and 28-day mortality in patients with sepsis. METHODS: This study was a multicenter retrospective cohort study of patients with sepsis or septic shock. The relationships between serum TCO2 and 28-day mortality, bicarbonate, pH, lactate, and anion gap were determined with cubic spline curves. The patients were divided into four groups according to their serum TCO2 concentration: Group I (TCO2 > 20 mmol/l), Group II (15 < TCO2 ≤ 20 mg/dl), Group III (10 < TCO2 ≤ 15 mmol/l), and Group IV (TCO2 ≤ 10 mmol/l). RESULTS: A total of 3168 patients were included in the analysis, and the overall mortality rate was 24.1%. Serum TCO2 concentrations below 20 mmol/l showed an almost linear correlation with mortality as well as with lactate, bicarbonate, and pH. The 28-day mortality rates of Group I, II, III, and IV were 18.3%, 23.6%, 32.6%, and 50.0%, respectively (p < .001). In Multivariable Cox proportional hazard regression analysis, the groups with lower serum TCO2 concentrations had a higher risk of 28-day mortality compared with Group I: Group II (Hazard ratio (HR), 1.35; 95% confidence interval (CI), 1.11-1.64), Group III (HR, 1.74; 95% CI, 1.37-2.21), and Group IV (HR, 2.72; 95% CI, 2.03-3.64). CONCLUSIONS: Serum TCO2 concentrations of 20 mmol/l or less were associated with 28-day mortality in patients with sepsis.
Authors: Salah Mohamed El Sayed; Moutasem Salih Aboonq; Yasmeen Talal Aljehani; Mohammad Ahmad Hassan; Rabab M Abou El-Magd; Abdelrahman I Abdelrahman; Rehab El-Tahlawi; Manal Mohamed Helmy Nabo; Reda S Yousef; Ahmed Alamir Mahmoud; Yasser Yahia Elsayed; Mostafa Abu-Elnaga; Tamer M Soliman; Abdelhady Ragab Abdel-Gawad; Momen Elshazley; Hussam Baghdadi; Samer El-Sawy; Hany Salah Mahmoud; Mariam E El-Anzi; Mansour Barakah Alharbi Journal: Am J Blood Res Date: 2020-12-15