Relationship of at Admission Lactate, Unmeasured Anions, and Chloride to the Outcome of Critically Ill Patients

被引:25
作者
Daniel Masevicius, Fabio [1 ]
Rubatto Birri, Paolo Nahuel [2 ]
Risso Vazquez, Alejandro [2 ]
Emanuel Zechner, Facundo [2 ]
Fernanda Motta, Maria [2 ]
Valenzuela Espinoza, Emilio Daniel [2 ]
Welsh, Sebastian [2 ]
Guerra Arias, Ernesto Fidel [2 ]
Andres Furche, Mariano [2 ]
Daniel Berdaguer, Fernando [2 ]
Dubin, Arnaldo [2 ]
机构
[1] Sanatorio Trinidad Ramos Mejia, Serv Terapia Intens, Ramos Mejia, Argentina
[2] Sanatorio Otamendi & Miroli, Serv Terapia Intens, Buenos Aires, DF, Argentina
关键词
chloride; lactate; metabolic acidosis; outcome; unmeasured anions; STRONG ION DIFFERENCE; METABOLIC-ACIDOSIS; HYPERCHLOREMIC ACIDOSIS; SERUM CHLORIDE; KIDNEY INJURY; BASE DEFICIT; MORTALITY; GAP; ASSOCIATION; SEVERITY;
D O I
10.1097/CCM.0000000000002730
中图分类号
R4 [临床医学];
学科分类号
1002 ; 100602 ;
摘要
Objectives: To investigate the association between the concentration of the causative anions responsible for the main types of metabolic acidosis and the outcome. Design: Prospective observational study. Setting: Teaching ICU. Patients: All patients admitted from January 2006 to December 2014. Interventions: None. Measurements and Main Results: Four thousand nine hundred one patients were admitted throughout the study period; 1,609 met criteria for metabolic acidosis and 145 had normal acid-base values. The association between at admission lactate, unmeasured anions, and chloride concentration with outcome was assessed by multivariate analysis in the whole cohort and in patients with metabolic acidosis. We also compared the mortality of patients with lactic, unmeasured anions, and hyperchloremic metabolic acidosis with that of patients without acid-base disorders. In the whole population, increased lactate and unmeasured anions were independently associated with increased mortality, even after adjusting for potential confounders (odds ratio [95% CI], 1.14 (1.08-1.20); p < 0.0001 and 1.04 (1.02-1.06); p < 0.0001, respectively). In patients with metabolic acidosis, the results were similar. Patients with lactic and unmeasured anions acidosis, but not those with hyperchloremic acidosis, had an increased mortality compared to patients without alterations (17.7%, 12.7%, 4.9%, and 5.8%, respectively; p < 0.05). Conclusions: In this large cohort of critically ill patients, increased concentrations of lactate and unmeasured anions, but not chloride, were associated with increased mortality. In addition, increased unmeasured anions were the leading cause of metabolic acidosis.
引用
收藏
页码:e1233 / e1239
页数:7
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