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.

Additional Metadata
Keywords Acidosis, Base deficit, Base excess, Critically ill, ICU, Lactate clearance, Lactate concentration, Ph, Risk stratification
Persistent URL dx.doi.org/10.1016/j.ejim.2020.02.027, hdl.handle.net/1765/125329
Journal European Journal of Internal Medicine
Citation
Wernly, B. (Bernhard), Heramvand, N. (Nadia), Masyuk, M. (Maryna), Rezar, R. (Richard), Bruno, R.R. (Raphael Romano), Kelm, M, … Jung, C. (2020). Acidosis predicts mortality independently from hyperlactatemia in patients with sepsis. European Journal of Internal Medicine. doi:10.1016/j.ejim.2020.02.027