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Title: Acidemia subtypes in critically ill patients: An international cohort study.
Austin Authors: Mochizuki, Katsunori;Fujii, Tomoko;Paul, Eldho;Anstey, Matthew;Uchino, Shigehiko;Pilcher, David V;Bellomo, Rinaldo 
Affiliation: Data Analytics Research and Evaluation (DARE) Centre
Intensive Care
Department of Intensive Care, Royal Melbourne Hospital, Melbourne, Victoria, Australia
Centre for Integrated Critical Care, Department of Medicine, The University of Melbourne, Parkville, Victoria, Australia
Australian and New Zealand Intensive Care Research Centre, Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
Intensive Care Unit, The Jikei University Hospital, Tokyo, Japan
Department of Emergency and Critical Care Medicine, Shinshu University School of Medicine, Matsumoto, Nagano, Japan
Department of Intensive Care, The Alfred, Melbourne, Victoria, Australia
The Australian and New Zealand Intensive Care Society Centre for Outcome and Resource Evaluation, Camberwell, Victoria, Australia
Intensive Care, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia
School of Medicine, University of Western Australia, Nedlands, Western Australia, Australia
Intensive Care Unit, The Jikei University Hospital, Tokyo, Japan
Issue Date: 26-Feb-2021
Date: 2021-02-26
Publication information: Journal of Critical Care 2021; 64: 10-17
Abstract: To study the prevalence, characteristic, outcome, and acid-base biomarker predictors of outcome for different acidemia subtypes. We used national intensive care databases from three countries and classified acidemia subtypes as metabolic (standard base excess [SBE] < -2 mEq/L only), respiratory (PaCO2 > 42 mmHg only), and combined (both SBE < -2 mEq/L and PaCO2 > 42 mmHg) based on blood gas analysis in the first 24 h after ICU admission. To investigate acid-base predictors for hospital mortality, we applied the area under the receiver operating characteristic curve approach. We screened 643,689 ICU patients (2014-2018) and detected acidemia in 57.8%. The most common subtype was metabolic (42.9%), followed by combined (30.3%) and respiratory (25.9%). Combined acidemia had a mortality of 12.7%, compared with 11% for metabolic and 5.5% for respiratory. For combined acidemia, the best predictor of hospital mortality was pH. However, for metabolic or respiratory acidemia, it was SBE or PaCO2, respectively. In ICU patients with acidemia, mortality differs according to subtype and is highest in the combined subtype. Best acid-base predictors of mortality also differ according to subtype with best performance for pH in combined, SBE in metabolic, and PaCO2 in respiratory acidemia.
DOI: 10.1016/j.jcrc.2021.02.006
Journal: Journal of Critical Care
PubMed URL: 33725556
Type: Journal Article
Subjects: Acidemia
Base excess
Metabolic acidosis
Mixed acidosis
Respiratory acidosis
Appears in Collections:Journal articles

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