Jiahui Liu, Yang Chen, Bin Yang, Jiabao Zhao, Qiang Tong, Yuan Yuan, Ye Kang, Tianshu Ren
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Kaplan-Meier survival analysis, Cox proportional hazards models, and restricted cubic spline analyses were used to examine the associations between ABE and mortality outcomes. The predictive performance of ABE combined with the SOFA score was assessed using the area under the curve, Net Reclassification Improvement, and Integrated Discrimination Improvement.</p><p><strong>Results: </strong>17,099 patients with sepsis were included in this analysis, with median (IQR) age of 67.82 (56.80, 78.04) years and 59.7% males. Our analysis revealed a U-shaped association between ABE and 30-day and 90-day ICU all-cause mortality. Both the lowest (Q1) and highest (Q4) quartiles of ABE were linked to increased mortality risks, with 30-day mortality showing HRs of 1.27 (95% CI 1.13-1.44) for Q1 and 1.17 (95% CI 1.06-1.31) for Q4, while 90-day mortality showed HRs of 1.28 (95% CI 1.16-1.44) for Q1, 1.12 (95% CI 1.02-1.23) for Q2, and 1.22 (95% CI 1.11-1.34) for Q4. ABE demonstrated superior predictive performance for mortality compared to BE and lactate. Incorporating ABE into the SOFA score improved predictive performance, emphasizing ABE's value in better risk stratification. The identified thresholds (2.5 mmol/L for 30-day mortality and 2.2 mmol/L for 90-day mortality) indicate optimal ABE levels that may be associated with improved survival outcomes.</p><p><strong>Conclusions: </strong>ABE demonstrated a U-shaped association with 30-day and 90-day ICU all-cause mortality in critically ill sepsis patients, suggesting its superiority over BE and lactate as a predictive biomarker. Incorporating ABE with the SOFA score may further enhance prognostic predictions. Further studies are needed to determine whether ABE should serve solely as a biomarker for monitoring the clinical course or could also be considered a potential therapeutic target.</p>","PeriodicalId":16123,"journal":{"name":"Journal of Intensive Care","volume":"13 1","pages":"20"},"PeriodicalIF":3.8000,"publicationDate":"2025-04-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11987327/pdf/","citationCount":"0","resultStr":"{\"title\":\"Association between alactic base excess on mortality in sepsis patients: a retrospective observational study.\",\"authors\":\"Jiahui Liu, Yang Chen, Bin Yang, Jiabao Zhao, Qiang Tong, Yuan Yuan, Ye Kang, Tianshu Ren\",\"doi\":\"10.1186/s40560-025-00789-9\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>Sepsis is a life-threatening condition often associated with metabolic and acid-base imbalances. 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引用次数: 0
摘要
背景:脓毒症是一种危及生命的疾病,通常与代谢和酸碱失衡有关。Alactic base excess (ABE)已成为评估危重脓毒症患者代谢紊乱的一种新的生物标志物,但其预后价值仍未得到充分探讨。我们的目的是调查在重症监护病房(ICU)设置的大型脓毒症队列中ABE与30天/90天ICU全因死亡率之间的关系。方法:本研究利用了来自美国ICU脓毒症大队列的数据。ABE计算自ICU入院第一天起的乳酸和碱过量(BE)值之和。根据ABE值将患者分为四分位数。Kaplan-Meier生存分析、Cox比例风险模型和限制性三次样条分析用于检验ABE与死亡率结果之间的关系。ABE结合SOFA评分的预测性能采用曲线下面积、净再分类改善和综合歧视改善进行评估。结果:17099例脓毒症患者纳入本分析,中位(IQR)年龄为67.82(56.80,78.04)岁,男性占59.7%。我们的分析显示ABE与30天和90天ICU全因死亡率呈u型相关。ABE的最低(Q1)和最高(Q4)四分位数都与死亡风险增加有关,30天死亡率第一季度的hr为1.27 (95% CI 1.13-1.44),第4季度的hr为1.17 (95% CI 1.06-1.31),而90天死亡率第一季度的hr为1.28 (95% CI 1.16-1.44),第二季度为1.12 (95% CI 1.02-1.23),第四季度为1.22 (95% CI 1.11-1.34)。与BE和乳酸相比,ABE显示出更好的死亡率预测性能。将ABE纳入SOFA评分可提高预测性能,强调ABE在更好的风险分层中的价值。确定的阈值(30天死亡率为2.5 mmol/L, 90天死亡率为2.2 mmol/L)表明最佳ABE水平可能与改善的生存结果相关。结论:ABE与危重症脓毒症患者30天和90天ICU全因死亡率呈u型相关,提示其作为预测性生物标志物优于BE和乳酸盐。将ABE与SOFA评分结合可以进一步提高预后预测。需要进一步的研究来确定ABE是否应该仅仅作为监测临床过程的生物标志物,或者也可以被视为潜在的治疗靶点。
Association between alactic base excess on mortality in sepsis patients: a retrospective observational study.
Background: Sepsis is a life-threatening condition often associated with metabolic and acid-base imbalances. Alactic base excess (ABE) has emerged as a novel biomarker to assess metabolic disturbances in critically ill sepsis patients, but its prognostic value remains underexplored. We aimed to investigate the relationship between ABE and 30-day/90-day ICU all-cause mortality in a large sepsis cohort in the intensive care unit (ICU) setting.
Methods: This study utilised data from a large US ICU sepsis cohort. ABE was calculated as the sum of lactate and base excess (BE) values from the first day of ICU admission. Patients were divided into quartiles based on ABE values. Kaplan-Meier survival analysis, Cox proportional hazards models, and restricted cubic spline analyses were used to examine the associations between ABE and mortality outcomes. The predictive performance of ABE combined with the SOFA score was assessed using the area under the curve, Net Reclassification Improvement, and Integrated Discrimination Improvement.
Results: 17,099 patients with sepsis were included in this analysis, with median (IQR) age of 67.82 (56.80, 78.04) years and 59.7% males. Our analysis revealed a U-shaped association between ABE and 30-day and 90-day ICU all-cause mortality. Both the lowest (Q1) and highest (Q4) quartiles of ABE were linked to increased mortality risks, with 30-day mortality showing HRs of 1.27 (95% CI 1.13-1.44) for Q1 and 1.17 (95% CI 1.06-1.31) for Q4, while 90-day mortality showed HRs of 1.28 (95% CI 1.16-1.44) for Q1, 1.12 (95% CI 1.02-1.23) for Q2, and 1.22 (95% CI 1.11-1.34) for Q4. ABE demonstrated superior predictive performance for mortality compared to BE and lactate. Incorporating ABE into the SOFA score improved predictive performance, emphasizing ABE's value in better risk stratification. The identified thresholds (2.5 mmol/L for 30-day mortality and 2.2 mmol/L for 90-day mortality) indicate optimal ABE levels that may be associated with improved survival outcomes.
Conclusions: ABE demonstrated a U-shaped association with 30-day and 90-day ICU all-cause mortality in critically ill sepsis patients, suggesting its superiority over BE and lactate as a predictive biomarker. Incorporating ABE with the SOFA score may further enhance prognostic predictions. Further studies are needed to determine whether ABE should serve solely as a biomarker for monitoring the clinical course or could also be considered a potential therapeutic target.
期刊介绍:
"Journal of Intensive Care" is an open access journal dedicated to the comprehensive coverage of intensive care medicine, providing a platform for the latest research and clinical insights in this critical field. The journal covers a wide range of topics, including intensive and critical care, trauma and surgical intensive care, pediatric intensive care, acute and emergency medicine, perioperative medicine, resuscitation, infection control, and organ dysfunction.
Recognizing the importance of cultural diversity in healthcare practices, "Journal of Intensive Care" also encourages submissions that explore and discuss the cultural aspects of intensive care, aiming to promote a more inclusive and culturally sensitive approach to patient care. By fostering a global exchange of knowledge and expertise, the journal contributes to the continuous improvement of intensive care practices worldwide.