Baseline serum bicarbonate levels independently predict short-term mortality in critically ill patients with ischaemic cardiogenic shock

Wigger, Olivier; Bloechlinger, Stefan; Berger, David; Häner, Jonas; Zanchin, Thomas; Windecker, Stephan; Räber, Lorenz; Schefold, Joerg C.

doi:10.1177/2048872616683526

Cited by 33 publications

(29 citation statements)

References 30 publications

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“…Previous studies in the USA and Switzerland have reported that a low serum bicarbonate level is associated with a higher mortality in patients with chronic kidney disease or ischemic cardiogenic shock . We suggest that lower initial serum bicarbonate levels at ED help to identify patients at risk of IHCA.…”

Section: Discussionmentioning

confidence: 65%

Predictors of in‐hospital cardiac arrest within 24 h after emergency department triage: A case–control study in urban Thailand

Srivilaithon

Amnuaypattanapon

Limjindaporn

et al. 2019

Emerg Medicine Australasia

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Objective This study describes the predictors of in‐hospital cardiac arrest (IHCA) within 24 h of ED triage and evaluates their ability to predict patients at risk of IHCA. Methods A case–control study was conducted in the ED. ‘Cases’ are herein defined as hospitalised patients who experienced IHCA within 24 h after ED triage. The exclusion criteria were those younger than 16 years old, cases of traumatic arrest, or had do‐not‐resuscitate orders. The controls were adults, non‐traumatic cases, who did not experience IHCA within 24 h of ED triage. A multivariable regression model was used to identify significant predictors of IHCA. The ability to discriminate was quantified by utilising an area under receiver operating characteristic (AuROC) curve. Results Two hundred and fifty IHCAs were compared with 1000 controls. Five predictors emerged that were: higher National Early Warning Score (NEWS) at triage, equal or increase of NEWS after ED management, coronary artery disease as a comorbid disease, the use of a vasoactive agent, and initial serum bicarbonate level lower than 23.5 mmoL/L, independently associated with IHCA. The AuROC of the final model from all predictors was 0.91 (95% CI 0.89–0.93) higher than NEWS alone model (AuROC at 0.78, 95% CI 0.74–0.81). Conclusions We conclude that a combination of NEWS and four independent predictors identify patients at risk of IHCA more effectively than NEWS alone.

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Section: Discussionmentioning

confidence: 65%

Predictors of in‐hospital cardiac arrest within 24 h after emergency department triage: A case–control study in urban Thailand

Srivilaithon

Amnuaypattanapon

Limjindaporn

et al. 2019

Emerg Medicine Australasia

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“…Serum bicarbonate, especially when assessed early in the course of patients at risk of CS may provide information regarding prognosis. In a recent study by Wigger et al serum bicarbonate decreased prior to significant elevation of lactate. A low bicarbonate level was a better predictor of 30‐day mortality than the highest recorded lactate level.…”

Section: Domains Of Patient Characteristicsmentioning

confidence: 89%

SCAI clinical expert consensus statement on the classification of cardiogenic shock

Baran

Grines

Bailey

et al. 2019

Cathet Cardio Intervent

688

358

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Background The outcome of cardiogenic shock complicating myocardial infarction has not appreciably changed in the last 30 years despite the development of various percutaneous mechanical circulatory support options. It is clear that there are varying degrees of cardiogenic shock but there is no robust classification scheme to categorize this disease state. Methods A multidisciplinary group of experts convened by the Society for Cardiovascular Angiography and Interventions was assembled to derive a proposed classification schema for cardiogenic shock. Representatives from cardiology (interventional, advanced heart failure, noninvasive), emergency medicine, critical care, and cardiac nursing all collaborated to develop the proposed schema. Results A system describing stages of cardiogenic shock from A to E was developed. Stage A is “at risk” for cardiogenic shock, stage B is “beginning” shock, stage C is “classic” cardiogenic shock, stage D is “deteriorating”, and E is “extremis”. The difference between stages B and C is the presence of hypoperfusion which is present in stages C and higher. Stage D implies that the initial set of interventions chosen have not restored stability and adequate perfusion despite at least 30 minutes of observation and stage E is the patient in extremis, highly unstable, often with cardiovascular collapse. Conclusion This proposed classification system is simple, clinically applicable across the care spectrum from pre‐hospital providers to intensive care staff but will require future validation studies to assess its utility and potential prognostic implications.

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“…One study linked reduced BE to occult tissue hypo-perfusion [ 32 ]. Two further studies in patients with trauma and cardiogenic shock revealed an associated with mortality, but without clear explanations on the underlying pathomechanisms [ 24 , 25 ]. However, it should be taken into account that decreased BE, as increased lactate, has potential confounders and may be related to multiple etiological factors.…”

Section: Discussionmentioning

confidence: 99%

“…Nevertheless, base excess was shown a strong predictor for mortality in specific subsets of ICU patients such as e.g. major trauma and in patients with cardiogenic shock [ 24 , 25 ]. However, whether the BD typically seen after cardiac surgery is actually related to the elevated lactate levels is currently controversially discussed [ 10 , 26 , 27 ].…”

Section: Introductionmentioning

confidence: 99%

Base excess is superior to lactate-levels in prediction of ICU mortality after cardiac surgery

Zante

Reichenspurner²,

Kubik

et al. 2018

PLoS ONE

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IntroductionCardiac surgery with the use of cardiopulmonary bypass is known to induce distinct metabolic changes. Respective changes in acid-base status including increased systemic lactate levels were previously related to clinical outcomes, but data remain controversial. Therefore, we aim to investigate the relevance of lactate and base excess (BE) levels on ICU-mortality in patients admitted to the ICU after cardiac surgery.Materials and methodsPerioperative data of patients treated in a tertiary care academic center admitted to the ICU after on-pump surgery were analyzed in a retrospective fashion. Receiver operation characteristic (ROC) curves were constructed for admission lactate-levels and BE with calculation of optimal cut-off values to predict ICU mortality. Univariate followed by multivariate regression models were constructed to identify potential outcome-relevant indices.ResultsData from 1,058 patients were included in the analysis. Area under the curves for prediction of ICU mortality were 0.79 for lactate levels at ICU admission (sensitivity 61.9%/ specificity 87.5%; optimal cut-off level 3.9mmol/l), and 0.7 for BE (sensitivity 52.4%/ specificity 93.8%, optimal cut-off level -6.7), respectively. Multivariate regression identified BE < -6.7 as the single metabolic predictor of ICU-mortality (HR 4.78, 95%-CI 1.4–16.33, p = 0.01). Explorative subgroup analyses revealed that the combination of lactate ≤3.9mmol/l and BE ≤ -6.7 has stronger impact on mortality than a combination of lactate of >3.9mmol/l and BE > -6.7 (HR 2.56, 95%-CI 0.18–37.17).ConclusionsAt ICU-admission, severely reduced BE appears superior to hyperlactatemia with regard to prediction of ICU-mortality in patients after cardiac surgery.

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Baseline serum bicarbonate levels independently predict short-term mortality in critically ill patients with ischaemic cardiogenic shock

Cited by 33 publications

References 30 publications

Predictors of in‐hospital cardiac arrest within 24 h after emergency department triage: A case–control study in urban Thailand

Predictors of in‐hospital cardiac arrest within 24 h after emergency department triage: A case–control study in urban Thailand

SCAI clinical expert consensus statement on the classification of cardiogenic shock

Base excess is superior to lactate-levels in prediction of ICU mortality after cardiac surgery

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