Association Between the Admission Serum Bicarbonate and Short-Term and Long-Term Mortality in Acute Aortic Dissection Patients Admitted to the Intensive Care Unit.

OBJECTIVE

Serum bicarbonate (HCO3) level is strongly related to multiple cardiovascular complications. Currently, there is no study evaluating the prognostic ability of serum HCO3 level in intensive care unit (ICU) patients with acute aortic dissection (AAD). Hence, this study was to assess the relationship between admission serum HCO3 level and clinical outcomes in patients with AAD.

DESIGN SETTINGS AND PARTICIPANTS

Clinical data were extracted from the MIMIC-III database. Cox proportional hazards models and Kaplan-Meier (KM) survival curve were used to evaluate the association between serum HCO3 levels and short- and long-term mortality in ICU patients with AAD. The subgroup analysis and the receiver operating characteristic (ROC) curve analysis and further KM survival curve based on best cut-off value were applied to assessment of the performance of HCO3 in predicting the mortality in each period (30 days, 90 days, 1 year and 5 years).

MAIN RESULTS

Firstly, 336 eligible patients were trisected to low-HCO3 level group (<22 mmol/L), mid-HCO3 level group (22-24 mmol/L) and high-HCO3 level group (>24 mmol/L). Then, in multivariate analysis, the serum HCO3 of low levels (<22 mmol/L) was a significant risk predictor of all-cause mortality in 30 days, 90 days, 1 year and 5 years. Subgroup analyses indicated that there is no interaction in most strata. Finally, areas under ROC curve ranged from 0.60 to 0.69.

CONCLUSION

The low HCO3 serum level measured at ICU admission significantly predicts short-term and long-term mortality in AAD patients.