Liang Minghao, Guan Feilong, Sun Lili, Xi Wenjing, Jia Hongling, Xu Yifei, Jin Minyan, Chen Xianhai, Huang Di, Qiu Zhanjun
First Clinical Medical College, Shandong University of Traditional Chinese Medicine, Jinan, China.
Department of Pulmonary Disease, Guang'anmen Hospital Jinan China Academy of Chinese Medical Sciences, Jinan, China.
Dose Response. 2025 Aug 27;23(3):15593258251374417. doi: 10.1177/15593258251374417. eCollection 2025 Jul-Sep.
The elevated mortality rate associated with sepsis is a primary global health concern. The correlation between bicarbonate levels and mortality risk in sepsis remains unclear.
A retrospective cohort study was conducted using data from the MIMIC-IV database, including 12 744 adult sepsis patients. The primary exposure was serum bicarbonate levels, categorized into quintiles. The primary outcome was 28-day mortality, and secondary outcomes included 90-day mortality. Multivariable Cox regression models adjusted for demographic, clinical, and laboratory variables were used to examine the relationship between bicarbonate levels and mortality. Curve fitting and sensitivity analyses were performed to validate the findings.
A U-shaped relationship between serum bicarbonate levels and 28-day mortality was identified. Both low (≤19.0 mEq/L) and high (>26.0 mEq/L) bicarbonate levels were associated with increased mortality risk. Patients with bicarbonate levels between 24.0-26.0 mEq/L had the lowest 28-day mortality. The relationship remained consistent across subgroups, and an inflection point was observed at 25.0 mEq/L. Sensitivity analyses confirmed the robustness of the findings across different data imputations.
This study demonstrates that both low and high serum bicarbonate levels are associated with increased mortality in sepsis patients. The optimal bicarbonate range for minimizing mortality risk appears to be between 24.0-26.0 mEq/L. These findings highlight the importance of monitoring bicarbonate levels in clinical practice, suggesting that maintaining bicarbonate within this range may improve patient outcomes. Further prospective studies are needed to confirm these findings and explore potential therapeutic strategies.
脓毒症相关的高死亡率是全球主要的健康问题。脓毒症中碳酸氢盐水平与死亡风险之间的相关性仍不明确。
利用多因素重症监护数据库-4（MIMIC-IV）的数据进行了一项回顾性队列研究，纳入了12744例成年脓毒症患者。主要暴露因素为血清碳酸氢盐水平，分为五分位数。主要结局为28天死亡率，次要结局包括90天死亡率。采用校正了人口统计学、临床和实验室变量的多变量Cox回归模型来研究碳酸氢盐水平与死亡率之间的关系。进行曲线拟合和敏感性分析以验证研究结果。
确定了血清碳酸氢盐水平与28天死亡率之间呈U形关系。低（≤19.0 mEq/L）和高（>26.0 mEq/L）碳酸氢盐水平均与死亡风险增加相关。碳酸氢盐水平在24.0 - 26.0 mEq/L之间的患者28天死亡率最低。该关系在各亚组中保持一致，在25.0 mEq/L处观察到一个拐点。敏感性分析证实了不同数据插补方法下研究结果的稳健性。
本研究表明，低和高血清碳酸氢盐水平均与脓毒症患者死亡率增加相关。将死亡风险降至最低的最佳碳酸氢盐范围似乎在24.0 - 26.0 mEq/L之间。这些发现凸显了在临床实践中监测碳酸氢盐水平的重要性，提示将碳酸氢盐维持在该范围内可能改善患者预后。需要进一步的前瞻性研究来证实这些发现并探索潜在的治疗策略。
