Effects of sodium bicarbonate infusion on mortality in medical-surgical ICU patients with metabolic acidosis-A single-center propensity score matched analysis.

Waskowski, J.; Hess, B.; Cioccari, L.; Irincheeva, I.; Pfortmueller, C. A.; Schefold, J. C. (2022). Effects of sodium bicarbonate infusion on mortality in medical-surgical ICU patients with metabolic acidosis-A single-center propensity score matched analysis. Medicina intensiva, 46(12), pp. 690-699. IDEPSA, International de Ediciones y Publicaciones, S.A. 10.1016/j.medin.2021.04.010

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OBJECTIVE

Metabolic acidosis is associated with high mortality. Despite theoretical benefits of sodium-bicarbonate (SB), current evidence remains controversial. We investigated SB-related effects on outcomes in ICU patients with metabolic acidosis.

DESIGN

Retrospective analysis.

SETTING

Academic medical center.

PATIENTS OR PARTICIPANTS

971 ICU patients with metabolic acidosis defined as arterial pH<7.3 and CO2<45mmHg treated between 2012 and 2016. A propensity score (PS) was estimated using logistic regression. Patients were matched in pairs using the PS.

INTERVENTIONS

441 patients were treated with SB 8.4% (SB-group) and n=530 patients were not (control group).

MAIN VARIABLES OF INTEREST

Primary outcome was all-cause mortality at ICU-discharge. Average Treatment Effect (ATE), Average Treatment effect in Treated (ATT), and estimated relative survival effects at 20 days were computed.

RESULTS

In the full cohort, we observed considerable differences in pH, base excess, additional acidosis-related indices, and ICU mortality (controls 31% vs. SB-group 56%, p<.001) at baseline between the two groups. After PS-matching (n=174 in each group), no significant difference in ICU mortality was observed (controls 32% vs. SB-group 41%; p=.07). Odds ratios (OR) for ATE and ATT showed no association with ICU mortality (OR ATE: 1.08, 95%-CI 0.99-1.17; p=.08; OR ATT 1.09; 95%-CI 0.99-1.2; p=.09). Hazard ratios at 20-days (multivariable HR, matched sample n=348: 1.16, 95%-CI 0.86-1.56, p=.33) showed similar survival in the two study groups.

CONCLUSIONS

We did not observe effects of SB infusion on all-cause mortality in critically ill patients with metabolic acidosis.

Item Type:

 Journal Article (Original Article)

Division/Institute:

 04 Faculty of Medicine > Department of Intensive Care, Emergency Medicine and Anaesthesiology (DINA) > Clinic of Intensive Care
04 Faculty of Medicine > Pre-clinic Human Medicine > Department of Clinical Research (DCR)
04 Faculty of Medicine > Department of Intensive Care, Emergency Medicine and Anaesthesiology (DINA) > Clinic and Policlinic for Anaesthesiology and Pain Therapy

UniBE Contributor:

 Waskowski, Jan, Hess, Benjamin, Cioccari, Luca (A), Irincheeva, Irina, Pfortmüller, Carmen, Schefold, Jörg Christian

Subjects:

 600 Technology > 610 Medicine & health

ISSN:

 0210-5691

Publisher:

 IDEPSA, International de Ediciones y Publicaciones, S.A.

Language:

 English

Submitter:

 Doris Kopp Heim

Date Deposited:

 22 Jun 2021 20:47

Last Modified:

 20 Feb 2024 14:15

Publisher DOI:

 10.1016/j.medin.2021.04.010

PubMed ID:

 34120787

Uncontrolled Keywords:

 Acidosis metabólica Bicarbonato de sodio Critical illness Enfermedad crítica ICU Metabolic acidosis Mortalidad Mortality Sodium bicarbonate UCI

BORIS DOI:

 10.48350/157052

URI:

 https://boris.unibe.ch/id/eprint/157052

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