Department of Clinical Medicine, Universidade Federal do Ceará, Av. Abolição, 4043 Ap 1203, Ed. Jangada, Fortaleza, CE, CEP 60165-082, Brazil,
Intensive Care Med. 2015 Mar;41(3):479-86. doi: 10.1007/s00134-015-3649-9. Epub 2015 Jan 20.
Although metabolic alkalosis is a common occurrence, no study has evaluated its prevalence, associated factors or outcomes in critically ill patients.
This is a retrospective study from the Multiparameter Intelligent Monitoring in Intensive Care II database. From 23,529 adult patient records, 18,982 patients met the inclusion criteria.
Serum bicarbonate levels demonstrated a U-shaped association with mortality with knots at 25 and 30 mEq/l. Of the total included patients, 5,565 (29.3 %) had at least one serum bicarbonate level measurement >30 mEq/l. The majority were exposed to multiple factors that are classically associated with metabolic alkalosis (mainly diuretic use, hypernatremia, hypokalemia and high gastric output). Patients with increased serum bicarbonate exhibited increased ICU LOS, more days on mechanical ventilation and higher hospital mortality. After multivariate adjustment, each 5-mEq/l increment in the serum bicarbonate level above 30 mEq/l was associated with an odds ratio of 1.21 for hospital mortality. The association between increased serum bicarbonate levels and mortality occurs independently of its possible etiologies.
An increased serum bicarbonate level is common in critically ill patients; this can be attributed to multiple factors in the majority of cases, and its presence and duration negatively influence patient outcomes.
尽管代谢性碱中毒很常见，但尚无研究评估其在危重症患者中的患病率、相关因素或结局。
这是一项来自 Multiparameter Intelligent Monitoring in Intensive Care II 数据库的回顾性研究。从 23529 名成年患者记录中，纳入了 18982 名符合条件的患者。
血清碳酸氢盐水平与死亡率呈 U 形关联，拐点在 25 和 30 mEq/l。在总共纳入的患者中，有 5565 名（29.3%）至少有一次血清碳酸氢盐水平测量值>30 mEq/l。这些患者主要暴露于多种与代谢性碱中毒相关的经典因素（主要是利尿剂使用、高钠血症、低钾血症和高胃输出）。血清碳酸氢盐升高的患者 ICU 住院时间延长、机械通气时间延长和住院死亡率升高。经过多变量调整后，血清碳酸氢盐水平每升高 5 mEq/l，超过 30 mEq/l，与医院死亡率的比值比为 1.21。血清碳酸氢盐水平升高与死亡率之间的关联独立于其可能的病因。
在危重症患者中，血清碳酸氢盐水平升高很常见；在大多数情况下，这归因于多种因素，其存在和持续时间对患者结局产生负面影响。
