Zhou Qiang, Miao Yuxiu, Li Fenghua, Liu Jianhua, Li Jianing, Li Na
Department of Orthopedic Surgery, Hekou District People's Hospital, Dongying City, China.
Department of Operating Theatre, Dongying People's Hospital (Dongying Hospital of Shandong Provincial Hospital Group), Dongying City, China.
Geriatr Gerontol Int. 2025 Mar;25(3):380-386. doi: 10.1111/ggi.15080. Epub 2025 Jan 20.
Septic older adults represent a vulnerable population with high mortality rates. Base excess (BE), an indicator of acid-base status, may serve as a prognostic marker in sepsis. This study aimed to investigate the association between BE and mortality in septic older adults.
A retrospective analysis included septic older adults (age ≥ 65 years) from the Medical Information Mart for Intensive Care (MIMIC)-IV database. The primary outcome was 30-day mortality. Multivariate Cox regression models and Kaplan-Meier analysis were used to assess the association between BE and 30-day mortality. A two-segment linear regression model with smooth curve fitting was employed to examine threshold effects of BE on clinical outcomes.
The study comprised 7379 participants, with a 21.8% 30-day mortality rate and an 18.6% in-hospital mortality rate. A nonlinear, U-shaped relationship (P < 0.001) was observed between BE and 30-day mortality in septic older adults, indicating increased risk with higher or lower BE levels. Various BE groups showed different hazard ratios for mortality: 2.7 (2.26-3.22), 1.86 (1.65-2.09), 1.41 (1.19-1.67), and 1.9 (1.4-2.58), respectively, compared with the reference group (-3 mEq/L ≤ BE < 3 mEq/L). The inflection point was calculated as 0.5 mEq/L.
Our findings suggest a U-shaped relationship between BE and mortality in septic older adults, emphasizing the importance of monitoring acid-base status in sepsis management for this population. Geriatr Gerontol Int 2025; 25: 380-386.
脓毒症老年患者是死亡率高的脆弱人群。碱剩余（BE）作为酸碱平衡状态的一个指标，可能是脓毒症的一个预后标志物。本研究旨在调查脓毒症老年患者中BE与死亡率之间的关联。
一项回顾性分析纳入了重症监护医学信息数据库（MIMIC-IV）中年龄≥65岁的脓毒症老年患者。主要结局为30天死亡率。采用多变量Cox回归模型和Kaplan-Meier分析来评估BE与30天死亡率之间的关联。采用带有平滑曲线拟合的两段线性回归模型来检验BE对临床结局的阈值效应。
该研究纳入了7379名参与者，30天死亡率为21.8%，住院死亡率为18.6%。在脓毒症老年患者中，观察到BE与30天死亡率之间呈非线性U型关系（P<0.001），表明BE水平过高或过低时死亡风险增加。与参照组（-3mEq/L≤BE<3mEq/L）相比，不同BE组的死亡风险比分别为2.7（2.26-3.22）、1.86（1.65-2.09）、1.41（1.19-1.67）和1.9（1.4-2.58）。拐点计算为0.5mEq/L。
我们的研究结果表明，脓毒症老年患者中BE与死亡率之间呈U型关系，强调了在该人群的脓毒症管理中监测酸碱平衡状态的重要性。《老年医学与老年病学国际杂志》2025年；25：380-386。
