Yang Ching Han, Chen Yee-An, Bin Pin-Jie, Ou Shuo-Ming, Tarng Der-Cherng
Division of Nephrology, Department of Medicine, Taipei Veterans General Hospital, 201, Section 2, Shih-Pai Road, Taipei, 11217, Taiwan.
Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.
Infect Dis Ther. 2023 Feb;12(2):687-701. doi: 10.1007/s40121-023-00765-6. Epub 2023 Feb 7.
Sepsis is characterized by a dysregulated host response to infection that leads to multiple organ dysfunction and often complicated with metabolic acidosis. However, the associations between serum total carbon dioxide level (TCO) and long-term clinical outcomes in sepsis survivors remains unknown.
A total of 7212 sepsis survivors aged ≥ 20 years who were discharged from January 1, 2008 to December 31, 2018 were included in our analyses. The sepsis survivors were further divided into high TCO (≥ 18 mmol/L) and low TCO (< 18 mmol/L) groups, comprising 5023 and 2189 patients, respectively. The following outcomes of interest were included: all-cause mortality, myocardial infarction, ischemic stroke, hospitalization for heart failure, ventricular arrhythmia, and end-stage renal disease (ESRD).
After propensity score matching, the low TCO group was at higher risks of all-cause mortality (hazard ratio [HR] 1.28, 95% confidence interval [95% CI] 1.18-1.39), myocardial infarction (HR 1.83, 95% CI 1.39-2.43), and ESRD (HR 1.38, 95% CI 1.16-1.64) than the high TCO group. The results remained similar after considering death as a competing risk.
Patients discharged from hospitalization for sepsis have higher risks of worse long-term clinical outcomes. Physicians may need to pay more attention to sepsis survivors whose TCO was low.
脓毒症的特征是宿主对感染的反应失调，导致多器官功能障碍，且常并发代谢性酸中毒。然而，脓毒症幸存者血清总二氧化碳水平（TCO）与长期临床结局之间的关联尚不清楚。
我们纳入了2008年1月1日至2018年12月31日期间出院的7212名年龄≥20岁的脓毒症幸存者进行分析。脓毒症幸存者进一步分为高TCO（≥18 mmol/L）组和低TCO（<18 mmol/L）组，分别包括5023例和2189例患者。纳入以下感兴趣的结局：全因死亡率、心肌梗死、缺血性中风、因心力衰竭住院、室性心律失常和终末期肾病（ESRD）。
倾向评分匹配后，低TCO组在全因死亡率（风险比[HR] 1.28，95%置信区间[95%CI] 1.18 - 1.39）、心肌梗死（HR 1.83，95%CI 1.39 - 2.43）和ESRD（HR 1.38，95%CI 1.16 - 1.64）方面比高TCO组风险更高。将死亡视为竞争风险后，结果仍然相似。
因脓毒症住院出院的患者长期临床结局较差的风险更高。医生可能需要更多关注TCO较低的脓毒症幸存者。
