Huang Yingxiu, Ao Ting, Zhen Peng, Hu Ming
Department of Infectious Disease, Beijing Luhe Hospital, Capital Medical University, Beijing, 101149, China.
Sci Rep. 2025 Jan 2;15(1):312. doi: 10.1038/s41598-024-84385-1.
The relationship between bicarbonate level and mortality in critically sick patients with infective endocarditis (IE) is currently not well established. The MIMIC-IV database was used to provide data for a retrospective cohort research. Included were patients with IE who were hospitalized to the critical care unit (ICU). Within the first 24 h following ICU admission, the serum bicarbonate was assessed. The 28-day mortality was the end-point result. To evaluate the relationship between the serum bicarbonate and 28-day mortality, multivariable Cox regression was employed. The study included 450 patients with IE in serious condition in the ICU, with a 57.4-year-old average and 64.2% male representation. The 28-day mortality rate stood at 20%. Unadjusted analysis revealed that higher serum bicarbonate levels upon ICU admission were significantly linked to reduced 28-day mortality (hazard ratio [HR], 0.90; 95% confidence interval [CI], 0.85-0.95; p < 0.001). This correlation remained significant after adjusting for potential confounding factors (adjusted HR, 0.94; 95% CI 0.89-0.99; p = 0.028). When categorizing bicarbonate levels, patients in the highest group (T3, ≥ 25 mEq/L) showed a significantly decreased adjusted HR of 0.55 (95% CI 0.33-0.93; p < 0.001) in relation to the control group (T1, ≤ 22 mEq/L) in the final model. Consistent results were observed in subgroup analyses across various groups. In patients with IE in the ICU, elevated serum bicarbonate upon admission was independently linked to a lower 28-day mortality. These findings indicate that serum bicarbonate can serve as a prognostic marker, supporting the process of risk assessment and providing direction for the clinical care of patients with IE.
目前，感染性心内膜炎（IE）危重症患者的碳酸氢盐水平与死亡率之间的关系尚未明确确立。MIMIC-IV数据库被用于为一项回顾性队列研究提供数据。纳入的患者为入住重症监护病房（ICU）的IE患者。在入住ICU后的最初24小时内，评估血清碳酸氢盐水平。28天死亡率为终点结果。为评估血清碳酸氢盐与28天死亡率之间的关系，采用了多变量Cox回归分析。该研究纳入了450例ICU中病情严重的IE患者，平均年龄为57.4岁，男性占64.2%。28天死亡率为20%。未调整分析显示，入住ICU时较高的血清碳酸氢盐水平与降低的28天死亡率显著相关（风险比[HR]，0.90；95%置信区间[CI]，0.85 - 0.95；p < 0.001）。在调整潜在混杂因素后，这种相关性仍然显著（调整后HR，0.94；95% CI 0.89 - 0.99；p = 0.028）。在对碳酸氢盐水平进行分类时，在最终模型中，最高组（T3，≥25 mEq/L）的患者相对于对照组（T1，≤22 mEq/L），调整后HR显著降低至0.55（95% CI 0.33 - 0.93；p < 0.001）。在各个亚组分析中均观察到一致的结果。在ICU的IE患者中，入院时血清碳酸氢盐升高与较低的28天死亡率独立相关。这些发现表明血清碳酸氢盐可作为一种预后标志物，支持风险评估过程，并为IE患者的临床护理提供指导。
