Clinical effectiveness of sodium bicarbonate therapy on mortality for septic patients with acute moderate lactic acidosis

Sai Huang; Bo Yang; Yaojun Peng; Qinrui Xing; Lili Wang; Jing Wang; Xuan Zhou; Yuan Yao; Li Chen; Cong Feng

doi:10.3389/fphar.2022.1059285

Clinical effectiveness of sodium bicarbonate therapy on mortality for septic patients with acute moderate lactic acidosis

Front Pharmacol. 2023 Jan 9:13:1059285. doi: 10.3389/fphar.2022.1059285. eCollection 2022.

Authors

Sai Huang^{1

2}, Bo Yang³, Yaojun Peng⁴, Qinrui Xing⁵, Lili Wang⁶, Jing Wang⁶, Xuan Zhou⁵, Yuan Yao⁷, Li Chen⁶, Cong Feng^{8

4

9

1}

Affiliations

¹ National Clinical Research Center of Geriatric Diseases, Chinese PLA General Hospital, Beijing, China.
² Department of Hematology, Fifth Medical Center of Chinese PLA General Hospital, Beijing, China.
³ Department of Thoracic Surgery, First Medical Center, General Hospital of PLA, Beijing, China.
⁴ Department of Emergency, First Medical Center of Chinese PLA General Hospital, Beijing, China.
⁵ Department of Emergency, Hainan Hospital of Chinese PLA General Hospital, Sanya, China.
⁶ Department of General Medicine, First Medical Center of General Hospital of People's Liberation Army, Beijing, China.
⁷ Hospital Management Institute, Medical innovation research department, Chinese PLA General Hospital, Beijing, China.
⁸ Department of General Medicine, Hainan Hospital of General Hospital of People's Liberation Army, Beijing, China.
⁹ State Key Laboratory of Kidney Diseases, National Clinical Research Center of Kidney Diseases, General Hospital of People's Liberation Army, Beijing, China.

Abstract

Objective: This study aimed to explore the effectiveness of sodium bicarbonate (SB) administration on mortality in septic patients with acute moderate lactic acidosis (MLA). Methods: The large ICU database (MIMIC-IV) was retrospectively analyzed. Patients with sepsis and acute MLA were identified. Propensity score analysis (PSA) was performed to explain baseline differences in the probability of accepting or not accepting SB. The edge structured cox model (MSCM) was used to adjust for baseline and time-varying confounding variables. The primary outcome was the ICU and hospital mortality. The subgroup of septic shock was also investigated. Results: A total of 512 septic patients with acute MLA were identified in this study, including 160 in the SB group and 352 in the non-SB group. In the PSA, SB administration was associated with reduced ICU (HR .58, 95% CI 0.38-.89; p <.05) and hospital (HR .67, 95% CI 0.47-.95; p <.05) mortality in septic patients with acute MLA. In the subgroup, the results were similar with septic patients. In the MSCM, SB administration could also improve the ICU (HR .35, 95% CI 0.16-.75; p <.01) and (HR .50, 95% CI 0.28-.88; p <.05) mortality on septic patients. However, In the subgroup, SB administration could only be found associated with improved hospital (HR .44, 95% CI 0.20-.97; p <.05) survival in septic shock. Conclusion: SB administration treatment could reduce ICU and hospital mortality of septic patients with acute MLA. Meanwhile, it could also improve hospital survival in the subgroup of septic shock patients with acute MLA.

Keywords: acute moderate lactic acidosis; mortality; sepsis; septic shock; sodium bicarbonate administration.

Grants and funding

We were grateful for the team of the Laboratory for Computational Physiology from the Massachusetts Institute of Technology (MIT-LCP) who kept the MIMIC databases. We also thank the support from the National Natural Science Fund (nos. 82072200, 82200169).