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Acidosis predicts mortality independently from hyperlactatemia in patients with sepsis

  • Bernhard Wernly
    Affiliations
    Clinic of Internal Medicine II, Department of Cardiology, Paracelsus Medical University of Salzburg, Salzburg, Austria

    Division of Cardiology, Department of Medicine, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
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  • Nadia Heramvand
    Affiliations
    Division of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty, Heinrich-Heine-University, Düsseldorf, Germany
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  • Maryna Masyuk
    Affiliations
    Division of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty, Heinrich-Heine-University, Düsseldorf, Germany
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  • Richard Rezar
    Affiliations
    Clinic of Internal Medicine II, Department of Cardiology, Paracelsus Medical University of Salzburg, Salzburg, Austria
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  • Raphael Romano Bruno
    Affiliations
    Division of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty, Heinrich-Heine-University, Düsseldorf, Germany
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  • Malte Kelm
    Affiliations
    Division of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty, Heinrich-Heine-University, Düsseldorf, Germany

    CARID, Cardiovascular Research Institute Düsseldorf, Medical Faculty, Heinrich-Heine-University, Düsseldorf, Germany
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  • David Niederseer
    Affiliations
    Department of Cardiology, University Heart Center Zurich, University Hospital Zurich, University of Zurich, Zurich, Switzerland
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  • Michael Lichtenauer
    Affiliations
    Clinic of Internal Medicine II, Department of Cardiology, Paracelsus Medical University of Salzburg, Salzburg, Austria
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  • Uta C Hoppe
    Affiliations
    Clinic of Internal Medicine II, Department of Cardiology, Paracelsus Medical University of Salzburg, Salzburg, Austria
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  • Jan Bakker
    Affiliations
    Department of Intensive Care Adults, Erasmus MC University Medical Center, Rotterdam, The Netherlands

    Department of Pulmonology and Critical Care, New York University Medical Center, New York, USA

    Department of Pulmonology and Critical Care, Columbia University Medical Center, New York, USA

    Department of Intensive Care, Pontificia Universidad Católica de Chile, Santiago, Chile
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  • Christian Jung
    Correspondence
    Corresponding author. Division of Cardiology, Pulmonology and Vascular Medicine, University Duesseldorf, Moorenstraße 5, 40225 Duesseldorf, Germany
    Affiliations
    Division of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty, Heinrich-Heine-University, Düsseldorf, Germany
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Published:March 03, 2020DOI:https://doi.org/10.1016/j.ejim.2020.02.027

      Highlights

      • In sepsis, acidosis and hyperlactatemia occur independently.
      • Acidosis and hyperlactatemia independently predict outcome.
      • The combination of hyperlactatemia and sepsis in a model yielded in higher predictiveness for mortality.

      Abstract

      Rationale and objectives

      Acidosis and hyperlactatemia predict outcome in critically ill patients. We assessed BE and pH for risk prediction capabilities in a sub-group of septic patients in the MIMIC-III database.

      Methods

      Associations with mortality were assessed by logistic regression analysis in 5586 septic patients. Baseline parameters, lactate concentrations, pH, and BE were analyzed at baseline and after 6 hours.

      Measurements and Main Results

      We combined acidosis (defined as either BE ≤-6 and/or pH ≤7.3) and hyperlactatemia and split the cohort into three subgroups: low-risk (no acidosis and lactate <2.3 mmol/L; n = 2294), medium-risk (either acidosis or lactate >2.3 mmol/L; n = 2125) and high-risk (both acidosis and lactate >2.3 mmol/L; n = 1167). Mortality was 14%, 20% and 38% (p<0.001) in low-risk, medium-risk and high-risk patients, respectively. The predictiveness of this model (AUC 0.63 95%CI 0.61-0.65) was higher compared to acidosis (AUC 0.59 95%CI 0.57-0.61; p<0.001) and lactate >2.3 mmol/L (AUC 0.60 95%CI 0.58-0.62; p<0.001) alone. Hyperlactatemia alone was only moderately predictive for acidosis (AUC 0.60 95%CI 0.59-0.62).

      Conclusions

      Acidosis and hyperlactatemia can occur independently to a certain degree. Combining acidosis and hyperlactatemia in a model yielded higher predictiveness for ICU-mortality. Septic patients with acidosis should be treated even more aggressively in the future.

      Keywords

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