PMID- 34307402
OWN - NLM
STAT- PubMed-not-MEDLINE
LR  - 20210727
IS  - 2296-858X (Print)
IS  - 2296-858X (Electronic)
IS  - 2296-858X (Linking)
VI  - 8
DP  - 2021
TI  - Risk Potential for Organ Dysfunction Associated With Sodium Bicarbonate Therapy 
      in Critically Ill Patients With Hemodynamic Worsening.
PG  - 665907
LID - 10.3389/fmed.2021.665907 [doi]
LID - 665907
AB  - Background: The role of sodium bicarbonate therapy (SBT) remains controversial. 
      This study aimed to investigate whether hemodynamic status before SBT contributed 
      to the heterogeneous outcomes associated with SBT in acute critically ill 
      patients. Methods: We obtained data from patients with metabolic acidosis from 
      the Medical Information Mart for Intensive Care (MIMIC)-III database. Propensity 
      score matching (PSM) was applied to match the SBT group with the control group. 
      Logistic regression and Cox regression were used to analyze a composite of newly 
      "developed or exacerbated organ dysfunction" (d/eOD) within 7 days of ICU 
      admission and 28-day mortality associated with SBT for metabolic acidosis. 
      Results: A total of 1,765 patients with metabolic acidosis were enrolled, and 332 
      pairs obtained by PSM were applied to the final analyses in the study. An 
      increased incidence of newly d/eOD was observed in the SB group compared with the 
      control group (54.8 vs. 44.6%, p < 0.01). Multivariable logistic regression 
      indicated that the adjusted OR of SBT for this composite outcome was no longer 
      significant [OR (95% CI): 1.39 (0.9, 1.85); p = 0.164]. This effect of SBT did 
      not change with the quintiles stratified by pH. Interestingly, SBT was associated 
      with an increased risk of the composite of newly d/eOD in the subgroup of 
      patients with worsening hemodynamics before SBT [adjusted OR (95% CI): 3.6 (1.84, 
      7.22), p < 0.001]. Moreover, the risk potential for this composite of outcomes 
      was significantly increased in patients characterized by both worsening [adjusted 
      OR (95% CI): 2.91 (1.54, 5.47), p < 0.001] and unchanged hemodynamics [adjusted 
      OR (95% CI): 1.94 (1.01, 3.72), p = 0.046] compared to patients with improved 
      hemodynamics before SBT. Our study failed to demonstrate an association between 
      SBT and 28-day mortality in acute critically ill patients with metabolic 
      acidosis. Conclusions: Our findings did not demonstrate an association between 
      SBT and outcomes in critically ill patients with metabolic acidosis. However, 
      patients with either worsening or unchanged hemodynamic status in initial 
      resuscitation had a significantly higher risk potential of newly d/eOD subsequent 
      to SBT.
CI  - Copyright (c) 2021 Wang, Yi, Zhang, Wang, Xi, Zeng, He, Zhang and Ma.
FAU - Wang, Tiehua
AU  - Wang T
AD  - Critical Care Medicine Department, Peking University Third Hospital, Beijing, 
      China.
FAU - Yi, Lingxian
AU  - Yi L
AD  - Critical Care Medicine Department, Strategic Support Force Characteristic Medical 
      Center of People's Liberation Army, Beijing, China.
FAU - Zhang, Hua
AU  - Zhang H
AD  - Research Center of Clinical Epidemiology, Peking University Third Hospital, 
      Beijing, China.
FAU - Wang, Tianhao
AU  - Wang T
AD  - Emergency Department, The 8th Medical Centre of Chinese People's Liberation Army 
      (PLA) General Hospital, Beijing, China.
FAU - Xi, Jingjing
AU  - Xi J
AD  - Critical Care Medicine Department, Peking University Third Hospital, Beijing, 
      China.
FAU - Zeng, Lin
AU  - Zeng L
AD  - Research Center of Clinical Epidemiology, Peking University Third Hospital, 
      Beijing, China.
FAU - He, Junlin
AU  - He J
AD  - Department of Medical Affairs, Shanghai Palan DataRx Co. Ltd., Shanghai, China.
FAU - Zhang, Zhongheng
AU  - Zhang Z
AD  - Department of Emergency Medicine, Sir Run Run Shaw Hospital, Zhejiang University 
      School of Medicine, Hangzhou, China.
FAU - Ma, Penglin
AU  - Ma P
AD  - Critical Care Medicine Department, Peking University Third Hospital, Beijing, 
      China.
AD  - Critical Care Medicine Department, Guiqian International General Hospital, 
      Guiyang, China.
LA  - eng
PT  - Journal Article
DEP - 20210707
PL  - Switzerland
TA  - Front Med (Lausanne)
JT  - Frontiers in medicine
JID - 101648047
PMC - PMC8292723
OTO - NOTNLM
OT  - critically ill patients
OT  - hemodynamic status
OT  - metabolic acidosis
OT  - organ dysfunction
OT  - sodium bicarbonate therapy
COIS- JH was employed by company Shanghai Palan DataRx Co. Ltd. The remaining authors 
      declare that the research was conducted in the absence of any commercial or 
      financial relationships that could be construed as a potential conflict of 
      interest.
EDAT- 2021/07/27 06:00
MHDA- 2021/07/27 06:01
PMCR- 2021/07/07
CRDT- 2021/07/26 06:38
PHST- 2021/02/09 00:00 [received]
PHST- 2021/06/11 00:00 [accepted]
PHST- 2021/07/26 06:38 [entrez]
PHST- 2021/07/27 06:00 [pubmed]
PHST- 2021/07/27 06:01 [medline]
PHST- 2021/07/07 00:00 [pmc-release]
AID - 10.3389/fmed.2021.665907 [doi]
PST - epublish
SO  - Front Med (Lausanne). 2021 Jul 7;8:665907. doi: 10.3389/fmed.2021.665907. 
      eCollection 2021.