nach oben

Intensive Care Medicine

Erschienen in:

25.09.2018 | Original

Effectiveness of sodium bicarbonate infusion on mortality in septic patients with metabolic acidosis

verfasst von: Zhongheng Zhang, Carlie Zhu, Lei Mo, Yucai Hong

Erschienen in: Intensive Care Medicine | Ausgabe 11/2018

Einloggen, um Zugang zu erhalten

Abstract

Objective

Although sodium bicarbonate (SB) solution has been widely used in clinical practice, its effect on mortality when administered to a large population of patients with acidosis is not known. The study aimed to investigate the effectiveness of SB infusion in septic patients with metabolic acidosis.

Methods

Septic patients with metabolic acidosis were identified from the Medical Information Mart for Intensive Care (MIMIC)-III database. Propensity score (PS) was used to account for the baseline differences in the probability to receive SB or not. The marginal structural Cox model (MSCM) was employed to adjust for both baseline and time-varying confounding factors.

Main results

A total of 1718 septic patients with metabolic acidosis were enrolled in the study, including 500 in the SB group and 1218 in the non-SB group. Both pH [7.16 (standard deviation (SD): 0.10) vs. 7.22 (SD: 0.07); p < 0.001] and bicarbonate concentration (BC) [11.84 (SD: 3.63) vs. 14.88 (SD: 3.36) mmol/l; p < 0.001] were significantly lower in the SB than that in the non-SB group. While there was no significant mortality effect in the overall population [hazard ratio (HR): 1.04; 95% CI 0.86–1.26; p = 0.67], SB was observed to be beneficial in patients with acute kidney injury (AKI) stage 2 or 3 and pH < 7.2 (HR 0.74; 95% CI 0.51–0.86; p = 0.021). Similar results were replicated with the MSCM.

Conclusion

Our study observed that SB infusion was not associated with improved outcome in septic patients with metabolic acidosis, but it was associated with improved survival in septic patients with AKI stage 2 or 3 and severe acidosis. The results need to be verified in randomized controlled trials.

Nur mit Berechtigung zugänglich

Angus DC, Linde-Zwirble WT, Lidicker J et al (2001) Epidemiology of severe sepsis in the United States: analysis of incidence, outcome, and associated costs of care. Crit Care Med 29:1303–1310CrossRefPubMed

Zhang Z, Ni H, Qian Z (2015) Effectiveness of treatment based on PiCCO parameters in critically ill patients with septic shock and/or acute respiratory distress syndrome: a randomized controlled trial. Intensive Care Med 41:444–451. https://doi.org/10.1007/s00134-014-3638-4 CrossRefPubMed

Raith EP, Udy AA, Bailey M et al (2017) Prognostic accuracy of the SOFA score, SIRS criteria, and qSOFA score for in-hospital mortality among adults with suspected infection admitted to the intensive care unit. JAMA 317:290–300. https://doi.org/10.1001/jama.2016.20328 CrossRefPubMed

Khwannimit B (2007) A comparison of three organ dysfunction scores: MODS, SOFA and LOD for predicting ICU mortality in critically ill patients. J Med Assoc Thail 90:1074–1081

Maciel AT, Noritomi DT, Park M (2010) Metabolic acidosis in sepsis. Endocr Metab Immune Disord Drug Targets 10:252–257CrossRefPubMed

Kellum JA (2004) Metabolic acidosis in patients with sepsis: epiphenomenon or part of the pathophysiology? Crit Care Resusc 6:197–203PubMed

Kraut JA, Madias NE (2012) Treatment of acute metabolic acidosis: a pathophysiologic approach. Nat Rev Nephrol 8:589–601. https://doi.org/10.1038/nrneph.2012.186 CrossRefPubMed

Gehlbach BK, Schmidt GA (2004) Bench-to-bedside review: treating acid–base abnormalities in the intensive care unit–the role of buffers. Crit Care 8:259–265. https://doi.org/10.1186/cc2865 CrossRefPubMedPubMedCentral

Sabatini S, Kurtzman NA (2009) Bicarbonate therapy in severe metabolic acidosis. J Am Soc Nephrol 20:692–695. https://doi.org/10.1681/asn.2007121329 CrossRefPubMed

10.

Jamme M, Ben Hadj Salem O, Guillemet L et al (2018) Severe metabolic acidosis after out-of-hospital cardiac arrest: risk factors and association with outcome. Ann Intensive Care 8:62. https://doi.org/10.1186/s13613-018-0409-3 CrossRefPubMedPubMedCentral

11.

Kraut JA, Kurtz I (2006) Use of base in the treatment of acute severe organic acidosis by nephrologists and critical care physicians: results of an online survey. Clin Exp Nephrol 10:111–117. https://doi.org/10.1007/s10157-006-0408-9 CrossRefPubMed

12.

Parker MJ, Parshuram CS (2013) Sodium bicarbonate use in shock and cardiac arrest: attitudes of pediatric acute care physicians. Crit Care Med 41:2188–2195. https://doi.org/10.1097/ccm.0b013e31828a6669 CrossRefPubMed

13.

Jaber S, Paugam C, Futier E et al (2018) Sodium bicarbonate therapy for patients with severe metabolic acidaemia in the intensive care unit (BICAR-ICU): a multicentre, open-label, randomised controlled, phase 3 trial. Lancet 392:31–40. https://doi.org/10.1016/s0140-6736(18)31080-8 CrossRefPubMed

14.

Robins JM, Hernán MÁ, Brumback B (2000) Marginal structural models and causal inference in epidemiology. Epidemiology 11:550–560. https://doi.org/10.1097/00001648-200009000-00011 CrossRefPubMed

15.

Johnson AEW, Pollard TJ, Shen L et al (2016) MIMIC-III, a freely accessible critical care database. Sci Data 3:160035. https://doi.org/10.1038/sdata.2016.35 CrossRefPubMedPubMedCentral

16.

Benchimol EI, Smeeth L, Guttmann A et al (2015) The REporting of studies Conducted using Observational Routinely-collected health Data (RECORD) statement. PLoS Med 12:e1001885. https://doi.org/10.1371/journal.pmed.1001885 CrossRefPubMedPubMedCentral

17.

Singer M, Deutschman CS, Seymour CW et al (2016) The third international consensus definitions for sepsis and septic shock (sepsis-3). JAMA 315(8):801–810CrossRefPubMedPubMedCentral

18.

Kidney Disease Improving Global Outcomes KDIGO Acute Kidney Injury Work Group (2012) KDIGO clinical practice guideline for acute kidney injury. Kidney Int Suppl 2:1–138CrossRef

19.

Zhang Z (2016) Missing data imputation: focusing on single imputation. Ann Transl Med 4:9. https://doi.org/10.3978/j.issn.2305-5839.2015.12.38 CrossRefPubMedPubMedCentral

20.

Zhang Z (2016) Univariate description and bivariate statistical inference: the first step delving into data. Ann Transl Med 4:91. https://doi.org/10.21037/atm.2016.02.11 CrossRefPubMedPubMedCentral

21.

Zhang Z, Gayle AA, Wang J et al (2017) Comparing baseline characteristics between groups: an introduction to the CBCgrps package. Ann Transl Med 5:484. https://doi.org/10.21037/atm.2017.09.39 CrossRefPubMedPubMedCentral

22.

Zhang Z (2017) Propensity score method: a non-parametric technique to reduce model dependence. Ann Transl Med 5:7. https://doi.org/10.21037/atm.2016.08.57 CrossRefPubMedPubMedCentral

23.

van der Wal WM, Geskus RB (2011) Ipw: an R Package for inverse probability weighting. J Stat Softw 43:1–23. https://doi.org/10.18637/jss.v043.i13 CrossRef

24.

Dupuis C, Garrouste-Orgeas M, Bailly S et al (2017) Effect of transfusion on mortality and other adverse events among critically ill septic patients: an observational study using a marginal structural cox model. Crit Care Med 45:1972–1980. https://doi.org/10.1097/ccm.0000000000002688 CrossRefPubMed

25.

de Keyser CE, Leening MJG, Romio SA et al (2014) Comparing a marginal structural model with a cox proportional hazard model to estimate the effect of time-dependent drug use in observational studies: statin use for primary prevention of cardiovascular disease as an example from the Rotterdam Study. Eur J Epidemiol 29:841–850. https://doi.org/10.1007/s10654-014-9951-y CrossRefPubMed

26.

Karim ME, Gustafson P, Petkau J et al (2014) Marginal structural cox models for estimating the association between β-interferon exposure and disease progression in a multiple sclerosis cohort. Am J Epidemiol 180:160–171. https://doi.org/10.1093/aje/kwu125 CrossRefPubMedPubMedCentral

27.

Ahn S, Kim Y-J, Sohn CH et al (2018) Sodium bicarbonate on severe metabolic acidosis during prolonged cardiopulmonary resuscitation: a double-blind, randomized, placebo-controlled pilot study. J Thorac Dis 10:2295–2302. https://doi.org/10.21037/jtd.2018.03.124 CrossRefPubMedPubMedCentral

28.

Mathieu D, Neviere R, Billard V et al (1991) Effects of bicarbonate therapy on hemodynamics and tissue oxygenation in patients with lactic acidosis: a prospective, controlled clinical study. Crit Care Med 19:1352–1356CrossRefPubMed

29.

Cooper DJ, Walley KR, Wiggs BR, Russell JA (1990) Bicarbonate does not improve hemodynamics in critically ill patients who have lactic acidosis. A prospective, controlled clinical study. Ann Intern Med 112:492–498CrossRefPubMed

30.

Kim HJ, Son YK, An WS (2013) Effect of sodium bicarbonate administration on mortality in patients with lactic acidosis: a retrospective analysis. PLoS One 8:e65283. https://doi.org/10.1371/journal.pone.0065283 CrossRefPubMedPubMedCentral

31.

Rhodes A, Evans LE, Alhazzani W et al (2017) Surviving sepsis campaign: international guidelines for management of sepsis and septic shock: 2016. Intensive Care Med. https://doi.org/10.1007/s00134-017-4683-6 CrossRefPubMedPubMedCentral

Titel: Effectiveness of sodium bicarbonate infusion on mortality in septic patients with metabolic acidosis
verfasst von: Zhongheng Zhang
Carlie Zhu
Lei Mo
Yucai Hong
Publikationsdatum: 25.09.2018
Verlag: Springer Berlin Heidelberg
Erschienen in: Intensive Care Medicine / Ausgabe 11/2018
Print ISSN: 0342-4642
Elektronische ISSN: 1432-1238
DOI: https://doi.org/10.1007/s00134-018-5379-2

Neu im Fachgebiet AINS

23.04.2024 | Appendizitis | Nachrichten

Update AINS

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.

hier abonnieren

Springer Medizin

Effectiveness of sodium bicarbonate infusion on mortality in septic patients with metabolic acidosis

Abstract

Objective

Methods

Main results

Conclusion

Neu im Fachgebiet AINS

Hinter dieser Appendizitis steckte ein Erreger

Ärztliche Empathie hilft gegen Rückenschmerzen

Mehr Schaden als Nutzen durch präoperatives Aussetzen von GLP-1-Agonisten?

S3-Leitlinie zu Pankreaskrebs aktualisiert

Update AINS

Springer Medizin

Abstract

Objective

Methods

Main results

Conclusion

Bitte loggen Sie sich ein, um Zugang zu diesem Inhalt zu erhalten

Weitere Artikel der Ausgabe 11/2018

What will junior editors add to Intensive Care Medicine?

Questions to improve family–staff communication in the ICU: a randomized controlled trial

Plasma angiopoietin-2 as a potential causal marker in sepsis-associated ARDS development: evidence from Mendelian randomization and mediation analysis

A walk after hemiplegia

Concordance of longitudinal strain and MRI in a case of myocardial contusion in a patient with normal conventional 2D echocardiography

Correction to: White paper: statement on conflicts of interest

Neu im Fachgebiet AINS

Hinter dieser Appendizitis steckte ein Erreger

Ärztliche Empathie hilft gegen Rückenschmerzen

Mehr Schaden als Nutzen durch präoperatives Aussetzen von GLP-1-Agonisten?

S3-Leitlinie zu Pankreaskrebs aktualisiert

Update AINS