Kim Jin Hee, Jang Dong-Hyun, Jo You Hwan, Suh Gil Joon, Kwon Woon Yong, Lee Jae Hyuk, Shin Jonghwan, Park Inwon, Lee Che Uk, Lee Sang-Min
Department of Emergency Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea.
Department of Emergency Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea.
Am J Emerg Med. 2021 Jun;44:277-283. doi: 10.1016/j.ajem.2020.04.006. Epub 2020 Apr 7.
Metabolic acidosis is commonly associated with the disease severity in patients with sepsis or septic shock. This study was performed to investigate the association between serum total carbon dioxide (TCO concentration and 28-day mortality in patients with sepsis.
This study was a multicenter retrospective cohort study of patients with sepsis or septic shock. The relationships between serum TCO and 28-day mortality, bicarbonate, pH, lactate, and anion gap were determined with cubic spline curves. The patients were divided into four groups according to their serum TCO concentration: Group I (TCO > 20 mmol/l), Group II (15 < TCO ≤ 20 mg/dl), Group III (10 < TCO ≤ 15 mmol/l), and Group IV (TCO ≤ 10 mmol/l).
A total of 3168 patients were included in the analysis, and the overall mortality rate was 24.1%. Serum TCO concentrations below 20 mmol/l showed an almost linear correlation with mortality as well as with lactate, bicarbonate, and pH. The 28-day mortality rates of Group I, II, III, and IV were 18.3%, 23.6%, 32.6%, and 50.0%, respectively (p < .001). In Multivariable Cox proportional hazard regression analysis, the groups with lower serum TCO concentrations had a higher risk of 28-day mortality compared with Group I: Group II (Hazard ratio (HR), 1.35; 95% confidence interval (CI), 1.11-1.64), Group III (HR, 1.74; 95% CI, 1.37-2.21), and Group IV (HR, 2.72; 95% CI, 2.03-3.64).
Serum TCO concentrations of 20 mmol/l or less were associated with 28-day mortality in patients with sepsis.
代谢性酸中毒通常与脓毒症或脓毒性休克患者的疾病严重程度相关。本研究旨在调查脓毒症患者血清总二氧化碳（TCO）浓度与28天死亡率之间的关联。
本研究是一项针对脓毒症或脓毒性休克患者的多中心回顾性队列研究。采用三次样条曲线确定血清TCO与28天死亡率、碳酸氢盐、pH值、乳酸和阴离子间隙之间的关系。根据血清TCO浓度将患者分为四组：第一组（TCO＞20mmol/L）、第二组（15＜TCO≤20mg/dl）、第三组（10＜TCO≤15mmol/L）和第四组（TCO≤10mmol/L）。
共有3168例患者纳入分析，总体死亡率为24.1%。血清TCO浓度低于20mmol/L与死亡率以及乳酸、碳酸氢盐和pH值呈几乎线性相关。第一组、第二组、第三组和第四组的28天死亡率分别为18.3%、23.6%、32.6%和50.0%（p＜0.001）。在多变量Cox比例风险回归分析中，与第一组相比，血清TCO浓度较低的组28天死亡风险更高：第二组（风险比（HR），1.35；95%置信区间（CI），1.11-1.64）、第三组（HR，1.74；95%CI，1.37-2.21）和第四组（HR，2.72；95%CI，2.03-3.64）。
脓毒症患者血清TCO浓度≤20mmol/L与28天死亡率相关。
