Huang Xia, Zhang Yuanyuan
Department of Neurology, Ninghai First Hospital, Ningbo, Zhejiang, China.
Emergency Medicine Department, Affiliated Hospital of Yangzhou University (Yangzhou First People's Hospital), Yangzhou, Jiangsu, China.
Front Neurol. 2023 May 24;14:1125359. doi: 10.3389/fneur.2023.1125359. eCollection 2023.
To explore the relationship between baseline bicarbonate levels and their changes with 30-day mortality in patients with acute ischemic stroke who were admitted to the intensive care unit (ICU).
This cohort study collected the data of 4,048 participants from the Medical Information Mart for Intensive Care (MIMIC)-III and MIMIC-IV databases. Univariate and multivariable Cox proportional risk models were utilized to explore the relationship between bicarbonate T0 and Δbicarbonate with 30-day mortality in patients with acute ischemic stroke. The Kaplan-Meier curves were plotted to measure the 30-day survival probability of patients with acute ischemic stroke.
The median follow-up time was 30 days. At the end of the follow-up, 3,172 patients survived. Bicarbonate T0 ≤ 21 mEq/L [hazard ratio (HR) = 1.24, a 95% confidence interval (CI): 1.02-1.50] or 21 mEq/L < bicarbonate T0 ≤ 23 mEq/L (HR = 1.29, 95%CI: 1.05-1.58) were associated with an increased risk of 30-day mortality in patients with acute ischemic stroke compared with bicarbonate T0 > 26 mEq/L. -2 mEq/L < Δbicarbonate ≤ 0 mEq/L (HR = 1.40, 95%CI: 1.14-1.71), 0 mEq/L < Δbicarbonate ≤ 2 mEq/L (HR = 1.44, 95%CI: 1.17-1.76), and Δbicarbonate >2 mEq/L (HR = 1.40, 95%CI: 1.15-1.71) were correlated with an elevated risk of 30-day mortality in acute ischemic stroke patients. The 30-day survival probability of acute ischemic stroke patients with 21 mEq/L < bicarbonate T0 ≤ 23 mEq/L, 23 mEq/L < bicarbonate T0 ≤ 26 mEq/L, or bicarbonate T0 >26 mEq/L was higher than that of patients with bicarbonate T0 ≤ 21 mEq/L. The 30-day survival probability was greater for patients in the Δbicarbonate ≤ -2 mEq/L group than for those in the Δbicarbonate >2 mEq/L group.
Low baseline bicarbonate levels and decreased bicarbonate levels during the ICU stay were associated with a high risk of 30-day mortality in acute ischemic stroke patients. Special interventions should be offered to those with low baseline and decreased bicarbonate levels during their ICU stay.
探讨入住重症监护病房（ICU）的急性缺血性脑卒中患者基线碳酸氢盐水平及其变化与30天死亡率之间的关系。
这项队列研究收集了医学重症监护信息数据库（MIMIC）-III和MIMIC-IV数据库中4048名参与者的数据。采用单变量和多变量Cox比例风险模型，探讨急性缺血性脑卒中患者碳酸氢盐T0和碳酸氢盐变化量（Δ碳酸氢盐）与30天死亡率之间的关系。绘制Kaplan-Meier曲线，以测量急性缺血性脑卒中患者的30天生存概率。
中位随访时间为30天。随访结束时，3172例患者存活。与碳酸氢盐T0>26 mEq/L相比，急性缺血性脑卒中患者的碳酸氢盐T0≤21 mEq/L（风险比[HR]=1.24，95%置信区间[CI]：1.02-1.50）或21 mEq/L<碳酸氢盐T0≤23 mEq/L（HR=1.29，95%CI：1.05-1.58）与30天死亡风险增加相关。-2 mEq/L<Δ碳酸氢盐≤0 mEq/L（HR=1.40，95%CI：1.14-1.71）、0 mEq/L<Δ碳酸氢盐≤2 mEq/L（HR=1.44，95%CI：1.17-1.76）和Δ碳酸氢盐>2 mEq/L（HR=1.40，95%CI：1.15-1.71）与急性缺血性脑卒中患者30天死亡风险升高相关。碳酸氢盐T0为21 mEq/L<碳酸氢盐T0≤23 mEq/L、23 mEq/L<碳酸氢盐T0≤26 mEq/L或碳酸氢盐T0>26 mEq/L的急性缺血性脑卒中患者的30天生存概率高于碳酸氢盐T0≤21 mEq/L的患者。Δ碳酸氢盐≤-2 mEq/L组患者的30天生存概率高于Δ碳酸氢盐>2 mEq/L组患者。
急性缺血性脑卒中患者基线碳酸氢盐水平低以及在ICU住院期间碳酸氢盐水平降低与30天死亡高风险相关。对于在ICU住院期间基线碳酸氢盐水平低且水平降低的患者，应提供特殊干预措施。
