无乳酸性碱剩余是脓毒症患者死亡的独立预测因子：一项倾向评分分析。
Alactic base excess is an independent predictor of death in sepsis: A propensity score analysis.
机构信息
Critical Care Department, Hospital Italiano de Buenos Aires, Argentina.
Critical Care Department, Hospital Italiano de Buenos Aires, Argentina; Internal Clinical Research Area, Hospital Italiano de Buenos Aires, Argentina; Institute of Translational Medicine and Biomedical Engineering, IUHI, CONICET, HIBA, Argentina.
出版信息
J Crit Care. 2023 Apr;74:154248. doi: 10.1016/j.jcrc.2022.154248. Epub 2023 Jan 12.
PURPOSE
Alactic base excess (ABE) is a novel biomarker defined as the sum of lactate and standard base excess and estimates the renal capability of handling acid-base disturbances in sepsis. The objective of this study is to see if ABE is an independent predictor of mortality in septic patients with and without renal dysfunction.
MATERIALS AND METHODS
We retrospectively studied 1178 patients with sepsis and septic shock. Patients were divided according to ABE values: 1) negative ABE (<-3 mmol/L); 2) neutral ABE (≥ - 3 and < 4 mmol/L); and 3) positive ABE (≥4 mmol/L). The effect of ABE on mortality was evaluated using Cox regression weight by inverse probability weighting (IPWT) analysis after propensity score assessment. Additionally, we performed a stratified analysis in patients with GFR > 60 mL/min/1.73 m2.
RESULTS
Negative ABE patients had higher mortality than patients with neutral ABE (adjusted HR 1.43; 95%CI 1.02-2.01). Also, in patients with GFR > 60 mL/min/1.73 m2 (n = 493), we observed higher mortality in patients with negative ABE (adjusted HR 2.43; 95%CI 1.07-5.53).
CONCLUSIONS
Negative ABE is an independent predictor of in-hospital mortality in septic patients with and without renal dysfunction.
目的
无乳酸性基础过剩（ABE）是一种新型生物标志物，定义为乳酸和标准基础过剩的总和，用于估计脓毒症患者处理酸碱紊乱的肾脏能力。本研究的目的是观察 ABE 是否是肾功能正常和异常的脓毒症患者死亡率的独立预测因子。
材料和方法
我们回顾性研究了 1178 例脓毒症和脓毒性休克患者。根据 ABE 值将患者分为三组：1）负 ABE（<-3mmol/L）；2）中性 ABE（≥-3 且<4mmol/L）；3）正 ABE（≥4mmol/L）。使用逆概率加权（IPWT）分析通过 Cox 回归权重评估 ABE 对死亡率的影响，在进行倾向评分评估后。此外，我们还在肾小球滤过率（GFR）>60mL/min/1.73m2 的患者中进行了分层分析。
结果
负 ABE 患者的死亡率高于中性 ABE 患者（调整后的 HR 1.43；95%CI 1.02-2.01）。此外，在 GFR>60mL/min/1.73m2 的患者（n=493）中，我们观察到负 ABE 患者的死亡率更高（调整后的 HR 2.43；95%CI 1.07-5.53）。
结论
负 ABE 是肾功能正常和异常的脓毒症患者住院死亡率的独立预测因子。
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