Association Between Base Excess and Mortality Among Patients in ICU With Acute Kidney Injury

Abstract

Objective: This study aimed to explore the association between base excess (BE) and the risk of 30-day mortality among patients with acute kidney injury (AKI) in the intensive care unit (ICU).Methods: This retrospective study included patients with AKI from the Medical Information Mart for Intensive Care (MIMIC)-IV database. We used a multivariate Cox proportional-hazards model to obtain the hazard ratio (HR) for the risk of 30-day mortality among patients with AKI. Furthermore, we utilized a Cox proportional-hazard model with restricted cubic splines (RCS) to explore the potential non-linear associations.Results: Among the 14,238 ICU patients with AKI, BE showed a U-shaped relationship with risk of 30-day mortality for patients with AKI, and higher or lower BE values could increase the risk. Compared with normal base excess (−3~3 mEq/L), patients in different groups (BE ≤ −9 mEq/L, −9 mEq/L < BE ≤ −3 mEq/L, 3 mEq/L < BE ≤ 9 mEq/L, and BE > 9 mEq/L) had different HRs for mortality: 1.57 (1.40, 1.76), 1.26 (1.14, 1.39), 0.97 (0.83, 1.12), 1.53 (1.17, 2.02), respectively. The RCS analyses also showed a U-shaped curve between BE and the 30-day mortality risk.Conclusion: Our results suggest that higher and lower BE in patients with AKI would increase the risk of 30-day mortality. BE measured at administration could be a critical prognostic indicator for ICU patients with AKI and provide guidance for clinicians.

Unsupervised clustering reveals phenotypes of AKI in ICU COVID-19 patients

“…For each, we fitted a univariable logistic spline regression modeling the logit of AKI. Natural restricted cubic splines with two degrees of freedom were used as nonlinear relations between AKI and frequently reported risk factors (25)(26)(27)(28)(29)(30).…”

“…They also displayed a higher recovery rate (HR = 1.6 for AKI recovery, 95% CI [1.0; 2.7], p = 0.05, Figure 3B). In addition, patients from cluster 3 also displayed a distinct metabolic profile, expressing the impaired metabolism profile at a higher rate (35% (26)(27)(28)(29)(30)(31)(32)(33)(34)(35)(36)(37)(38)(39)(40)(41)(42)(43) vs. 27% (22-31) p = 0.04, Figure 3C), and had a higher hospital mortality (55% vs. 20% (11-29) p < 0.001, Figure 3D). Finally, only patients from cluster 3 exhibit a significant positive association between AKI severity and risk of hospital mortality (Figure 3E).…”

The association between albumin corrected anion gap and ICU mortality in acute kidney injury patients requiring continuous renal replacement therapy

“…In addition, several other studies have also explored the relationships between metabolic acidosis and clinical outcomes of AKI patients. Cheng Y et al [ 29 ] found a U-shaped association between base excess value measured at the ICU admission and 30 day all-cause mortality in critically AKI patients, and both lower (≤ − 3 mEq/L)and higher (≥ 9 mEq/L) base excess would increase the risk of 30 day all-cause mortality. One latest study by Uusalo and colleagues [ 30 ] acknowledged that for perioperative AKI patients requiring CRRT, blood lactate at ICU admission and CRRT initiation were both independently associated with mortality.…”

Unsupervised clustering reveals phenotypes of AKI in ICU Covid19 patients

“…Using these pre-processed data, we fitted the relation between AKI and each potential predictor in a univariable fashion, using a logistic regression. As nonlinear relations between AKI and risk factors have often been reported [25][26][27][28][29][30] we also fitted a logistic regression using natural restricted cubic splines with two degrees of freedom.…”

“…Patients from clusters 1 and 2 also showed a distinct metabolic profile compared to cluster 3, expressing the impaired metabolism profile at a lower rate (22% [19][20][21][22][23][24] versus 29% [23][24][25][26][27][28][29][30][31][32][33] p=0.005, Figure 3d).…”