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Physiological variables of the “metabolic component” of acid-base balance and mortality in intensive care patients
Variables fisiológicas del “componente metabólico” del estado ácido base y mortalidad en pacientes de cuidados intensivos
Palabras clave:
Acid Base Equilibrium, Metabolic Acidosis, Critical Care Outcome (en)Equilibrio ácido-base, Acidosis metabólica, Resultados de cuidados críticos (es)
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Introduction: Metabolic acidosis is a frequent pathophysiological condition in critically ill patients. It can be assessed using different physiological variables, but their prognostic value has not yet been well established.
Objective: To evaluate the association between the variables that allow assessing the metabolic component of acid-base balance (ABB) and 28-day mortality in patients admitted to an intensive care unit (ICU) in Bogotá, D.C., Colombia.
Materials and methods: Prospective cohort study conducted in 122 patients admitted to an ICU between January and June 2013 and with a stay >24 hours. On admission to the ICU, blood samples were taken, and an arterial blood gas test was performed in order to calculate the following variables: anion gap (AG), corrected anion gap (AGc), standard base excess (BEst), metabolic H+, base excess-unmeasurable anions (BEua), arterial pH, arterial lactate, standard HCO3-st, and strong ion difference (SID). APACHE II and SOFA scores were also calculated. A bivariate analysis was performed in which ORs and their respective 95%CI were calculated, and then a multivariate analysis was conducted using a logistic regression model to identify the variables associated with 28-day mortality; a significance level of p<0.05 was considered.
Results: Out of the 122 patients, 33 (27.05%) died at 28 days and 51 (48.80%) were women. Participants’ mean age was 46.5 years (±15.7). The following variables were significantly associated with 28-day mortality in the bivariate analysis: SID (OR=1.150; p=0.008), BEua (OR=0.897; p=0.023), AG (OR=1.231; p=0.002), AGc (OR=1.232; p=0.003), blood pH (OR=0.001; p=0.023), APACHE II (OR=1.180; p=0.001), HCO3-st (OR=0.841; p=0.015). In the multivariate analysis, only the APACHE II score variable was significantly associated with 28-day mortality (OR=1.188; p=0.008).
Conclusion: The physiological variables that allow assessing the metabolic component of ABB, both from the Henderson model and the Stewart model, were not significantly associated with 28-day mortality.
Introducción. La acidosis metabólica es una condición fisiopatológica frecuente en pacientes críticamente enfermos. Esta alteración es evaluada mediante diferentes variables fisiológicas; sin embargo, su valor pronóstico aún no está bien definido.
Objetivo. Evaluar la asociación entre, por una parte, las variables del componente metabólico que permiten valorar el estado ácido base (EAB) y, por la otra, la mortalidad a 28 días en pacientes hospitalizados en una unidad de cuidados intensivos (UCI) en Bogotá D.C., Colombia.
Materiales y métodos. Estudio de cohorte prospectivo realizado en 122 pacientes hospitalizados en una UCI entre enero y junio de 2013 y con una estancia mayor a 24 horas. Se tomaron muestras sanguíneas y gases arteriales de ingreso a UCI para el cálculo de las siguientes variables: anion gap (AG), anion gap corregido (AGc), base exceso estándar (BEst), H+ metabólicos, base exceso-aniones no medibles (BEua), pH arterial, lactato arterial, HCO3-st y brecha de iones fuertes (BIF). También se calcularon el puntaje APACHE II y el puntaje SOFA. Se realizó un análisis bivariado en el que se calcularon OR y sus respectivos IC95%, y luego uno multivariado, mediante un modelo de regresión logística, para identificar las variables asociadas con la mortalidad a 28 días; se consideró un nivel de significancia de p<0.05
Resultados. De los 122 pacientes, 33 (27.05%) fallecieron a 28 días y 51 (48.80%) eran mujeres. La edad promedio fue 46.5 años (±15.7). En el análisis bivariado, las siguientes variables se asociaron significativamente con la mortalidad a 28 días: BIF (OR=1.150; p=0.008), BEua (OR=0.897; p=0.023), AG (OR=1.231; p=0.002), AGc (OR=1.232; p=0.003), pH arterial (OR=0.001; p=0.023), APACHE II (OR=1.180; p=0.001), HCO3-st (OR=0.841; p=0.015). En el análisis multivariado, solo el puntaje APACHE II se asoció significativamente con la mortalidad a 28 días (OR=1.188; p=0.008).
Conclusión. Las variables fisiológicas que permiten evaluar el componente metabólico del EAB, tanto las del modelo de Henderson, como las del modelo de Stewart, no se asociaron significativamente con la mortalidad a 28 días.
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Hall J, Hall ME. Acid-Base Regulation. In: Hall J, Hall ME. Guyton and Hall Textbook of Medical Physiology. 14th ed. Elsevier; 2021. p. 403-20.
Diaztagle-Fernández JJ, Moreno-Ladino IJ, Morcillo-Muñoz JA, Morcillo-Muñoz AF, Marcelo-Pinilla LA, Cruz-Martínez LE. Comparative analysis of acid-base balance in patients with severe sepsis and septic shock: traditional approach vs. physicochemical approach. Rev. Fac. Med. 2019;67(4):629-34. https://doi.org/jsch.
Jaber S, Paugam C, Futier E, Lefrant JY, Lasocki S, Lescot T, et al. BICAR-ICU Study Group. Sodium bicarbonate therapy for patients with severe metabolic acidaemia in the intensive care unit (BICAR-ICU): a multicentre, open-label, randomised controlled, phase 3 trial. Lancet. 2018;392(10141):31-40. https://doi.org/gdvx4p.
Fujii T, Udy AA, Nichol A, Bellomo R, Deane AM, El-Khawas K, Thummaporn N, et al. SODA-BIC investigators. Incidence and management of metabolic acidosis with sodium bicarbonate in the ICU: An international observational study. Crit Care. 2021;25(1):45. https://doi.org/jsck.
Waskowski J, Hess B, Cioccari L, Irincheeva I, Pfortmueller CA, Schefold JC. Effects of sodium bicarbonate infusion on mortality in medical-surgical ICU patients with metabolic acidosis-A single-center propensity score matched analysis. Medicina Intensiva. 2022;46(12):690-9. https://doi.org/jscm.
Dubin A, Menises MM, Masevicius FD, Moseinco MC, Kutscherauer DO, Ventrice E, et al. Comparison of three different methods of evaluation of metabolic acid-base disorders. Crit Care Med. 2007;35(5):1264-70. https://doi.org/c6p4dt.
Cruz, LE, Diaztagle JJ, Giraldo E, Melo CE, Sprockel JJ. Comparación de diferentes medidas para el abordaje fisiológico del estado ácido - base en pacientes críticos: papel de los hidrogeniones metabólicos (H+ met). Acta Colomb Cuid Intensivo. 2009;9(2):131-4.
Fores-Novales B, Diez-Fores P, Aguilera-Celorrio LJ. Assessment of acid-base balance. Stewart’s approach. Rev Esp Anestesiol Reanim. 2016;63(4):212-9. https://doi.org/f3g8n7.
Zingg T, Bhattacharya B, Maerz LL. Metabolic acidosis and the role of unmeasured anions in critical illness and injury. J Surg Res. 2018;224:5-17. https://doi.org/gc8j3m.
Kramer AA, Zimmerman JE, Knaus WA. Severity of Illness and Predictive Models in Society of Critical Care Medicine’s First 50 Years: A Tale of Concord and Conflict. Crit Care Med. 2021;49(5):728-40. https://doi.org/gnws54.
Ortega M, Cayuela A. Regresión logística no condicionada y tamaño de muestra: una revisión bibliográfica. Rev Esp Salud Publica. 2002;76:85-93.
World Medical Association (WMA). WMA Declaration of Helsinki – Ethical principles for medical research involving human subjects. Fortaleza: 64th WMA General Assembly; 2013.
Colombia. Ministerio de Salud. Resolución 8430 de 1993 (octubre 4): Por la cual se establecen las normas científicas, técnicas y administrativas para la investigación en salud. Bogotá D.C.; octubre 4 de 1993 [cited 2020 Oct 30]. Available from: https://bit.ly/31gu7do.
Vincent JL, Quintairos ESA, Couto L Jr, Taccone FS. The value of blood lactate kinetics in critically ill patients: a systematic review. Crit Care. 2016;20(1):257. https://doi.org/f8xbk4.
Baysan M, Baroni GD, van Boekel AM, Steyerberg EW, Arbous MS, van der Bom JG. The Added Value of Lactate and Lactate Clearance in Prediction of In-Hospital Mortality in Critically Ill Patients With Sepsis. Crit Care Explor. 2020;2(3):e0087. https://doi.org/ghh2rh.
Pan J, Peng M, Liao C, Hu X, Wang A, Li X. Relative efficacy and safety of early lactate clearance-guided therapy resuscitation in patients with sepsis: A meta-analysis. Medicine (Baltimore). 2019;98(8):e14453. https://doi.org/ggbhbg.
Passos RDH, Caldas JR, Ramos JGR, Batista PBP, Noritomi DT, Akamine N, et al. Acid base variables predict survival early in the course of treatment with continuous venovenous hemodiafiltration. Medicine (Baltimore). 2018;97(36):e12221. doi: https://doi.org/jscq.
Zante B, Reichenspurner H, Kubik M, Kluge S, Schefold JC, Pfortmueller CA. Base excess is superior to lactate-levels in prediction of ICU mortality after cardiac surgery. PLoS One. 2018;13(10):e0205309. https://doi.org/gfdmg9.
Qi J, Bao L, Yang P, Chen D. Comparison of base excess, lactate and pH predicting 72-h mortality of multiple trauma. BMC Emerg Med. 2021;21(1):80. https://doi.org/jscr.
Bini R, Accardo C, Granieri S, Sammartano F, Cimbanassi S, Renzi F, et al. Independent Predictors of Mortality in Torso Trauma Injuries. J Clin Med. 2020;9(10):3202. https://doi.org/jscs.
Peñasco Y, González-Castro A, Rodríguez-Borregán JC, Llorca J. Exceso de bases, un marcador útil en el pronóstico del traumatismo torácico en la población geriátrica. Rev. esp. anestesiol. reanim. 2017;64(5):250-6. https://doi.org/jscv.
Masevicius FD, Rubatto Birri PN, Risso Vazquez A, Zechner FE, Motta MF, et al. Relationship of at Admission Lactate, Unmeasured Anions, and Chloride to the Outcome of Critically Ill Patients. Crit Care Med. 2017;45(12):e1233-9. https://doi.org/jscw.
Kaplan LJ, Kellum JA. Comparison of acid-base models for prediction of hospital mortality after trauma. Shock. 2008;29(6):662-6. https://doi.org/crphwx.
Gucyetmez B, Atalan HK. Non-lactate strong ion difference: a clearer picture. J Anesth. 2016;30(3):391-6. https://doi.org/jscx.
Cusack RJ, Rhodes A, Lochhead P, Jordan B, Perry S, Ball JA, et al. The strong ion gap does not have prognostic value in critically ill patients in a mixed medical/surgical adult ICU. Intensive Care Med. 2002;28(7):864-9. https://doi.org/dkr84f.
Ratanarat R, Sodapak C, Poompichet A, Toomthong P. Use of different approaches of acid-base derangement to predict mortality in critically ill patients. J Med Assoc Thai. 2013;96(2):216.
Ho KM, Lan NS, Williams TA, Harahsheh Y, Chapman AR, Dobb GJ, et al. A comparison of prognostic significance of strong ion gap (SIG) with other acid-base markers in the critically ill: a cohort study. J Intensive Care. 2016;4:43. https://doi.org/gmhgq7.
Rocktaeschel J, Morimatsu H, Uchino S, Bellomo R. Unmeasured anions in critically ill patients: can they predict mortality? Crit Care Med. 2003;31(8):2131-6. https://doi.org/dbnjvm.
Glasmacher SA, Stones W. Anion gap as a prognostic tool for risk stratification in critically ill patients - a systematic review and meta-analysis. BMC Anesthesiol. 2016;16(1):68. https://doi.org/gmhgq4.
Lipnick MS, Braun AB, Cheung JT, Gibbons FK, Christopher KB. The difference between critical care initiation anion gap and prehospital admission anion gap is predictive of mortality in critical illness. Crit Care Med. 2013;41(1):49-59. https://doi.org/jscz.
Oliveros H, Denis R, Rodríguez M. Evaluación del desempeño de los aniones no medibles calculados por la diferencia de ion fuerte como marcador de disfunción orgánica múltiple. Acta Colomb Cuid Intensivo. 2003;6(2):129-40.
Spoelstra-de Man AM, Smorenberg A, Groeneveld AB. Different effects of fluid loading with saline, gelatine, hydroxyethyl starch or albumin solutions on acid-base status in the critically ill. PLoS One. 2017;12(4):e0174507. https://doi.org/f9xjjr.
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Derechos de autor 2021 Revista de la Facultad de Medicina
Esta obra está bajo una licencia Creative Commons Reconocimiento 3.0 Unported.
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