Association Between the Admission Serum Bicarbonate and Short-Term and Long-Term Mortality in Acute Aortic Dissection Patients Admitted to the Intensive Care Unit

Association between serum bicarbonate and 28-day mortality in critically ill patients with infective endocarditis: a cohort study from MIMIC-IV

The relationship between bicarbonate level and mortality in critically sick patients with infective endocarditis (IE) is currently not well established. The MIMIC-IV database was used to provide data for a retrospective cohort research. Included were patients with IE who were hospitalized to the critical care unit (ICU). Within the first 24 h following ICU admission, the serum bicarbonate was assessed. The 28-day mortality was the end-point result. To evaluate the relationship between the serum bicarbonate and 28-day mortality, multivariable Cox regression was employed. The study included 450 patients with IE in serious condition in the ICU, with a 57.4-year-old average and 64.2% male representation. The 28-day mortality rate stood at 20%. Unadjusted analysis revealed that higher serum bicarbonate levels upon ICU admission were significantly linked to reduced 28-day mortality (hazard ratio [HR], 0.90; 95% confidence interval [CI], 0.85-0.95; p < 0.001). This correlation remained significant after adjusting for potential confounding factors (adjusted HR, 0.94; 95% CI 0.89-0.99; p = 0.028). When categorizing bicarbonate levels, patients in the highest group (T3, ≥ 25 mEq/L) showed a significantly decreased adjusted HR of 0.55 (95% CI 0.33-0.93; p < 0.001) in relation to the control group (T1, ≤ 22 mEq/L) in the final model. Consistent results were observed in subgroup analyses across various groups. In patients with IE in the ICU, elevated serum bicarbonate upon admission was independently linked to a lower 28-day mortality. These findings indicate that serum bicarbonate can serve as a prognostic marker, supporting the process of risk assessment and providing direction for the clinical care of patients with IE.

Mortality, Functional Status, and Quality of Life after 5 Years of Patients Admitted to Critical Care for Spontaneous Intracerebral Hemorrhage

BACKGROUND

The objective of this study was to assess long-term outcome in patients with spontaneous intracerebral hemorrhage admitted to the intensive care unit.

METHODS

Mortality and Glasgow Outcome Scale, Barthel Index, and 5-level EQ-5D version (EQ-5D-5L) scores were analyzed in a multicenter cohort study of three Spanish hospitals (336 patients). Mortality was also analyzed in the Medical Information Mart for Intensive Care III (MIMIC-III) database.

RESULTS

The median (25th percentile-75th percentile) age was 62 (50-70) years, the median Glasgow Coma Score was 7 (4-11) points, and the median Acute Physiology and Chronic Health disease Classification System II (APACHE-II) score was 21 (15-26) points. Hospital mortality was 54.17%, mortality at 90 days was 56%, mortality at 1 year was 59.2%, and mortality at 5 years was 66.4%. In the Glasgow Outcome Scale, a normal or disabled self-sufficient situation was recorded in 21.5% of patients at 6 months, in 25.5% of patients after 1 year, and in 22.1% of patients after 5 years of follow-up (4.5% missing). The Barthel Index score of survivors improved over time: 50 (25-80) points at 6 months, 70 (35-95) points at 1 year, and 90 (40-100) points at 5 years (p < 0.001). Quality of life evaluated with the EQ-5D-5L at 1 year and 5 years indicated that greater than 50% of patients had no problems or slight problems in all items (mobility, self-care, usual activities, pain/discomfort, and anxiety/depression). In the MIMIC-III study (N = 1354), hospital mortality was 31.83% and was 40.5% at 90 days and 56.2% after 5 years.

CONCLUSIONS

In patients admitted to the intensive care unit with a diagnosis of nontraumatic intracerebral hemorrhage, hospital mortality up to 90 days after admission is very high. Between 90 days and 5 years after admission, mortality is not high. A large percentage of survivors presented a significant deficit in quality of life and functional status, although with progressive improvement over time. Five years after the hemorrhagic stroke, a survival of 30% was observed, with a good functional status seen in 20% of patients who had been admitted to the hospital.

Association between baseline serum bicarbonate and the risk of postoperative delirium in patients undergoing cardiac surgery in the ICU: a retrospective study from the MIMIC-IV database

BACKGROUND

Although serum bicarbonate is a reliable predictor of various disease complications, its relationship with postoperative delirium (POD) remains unclear. Our research aimed to assess the effect of baseline serum bicarbonate levels on the incidence of POD in cardiac surgery patients.

METHODS

A retrospective analysis was conducted on cardiac surgery patients who met specific inclusion and exclusion criteria, using data from the Marketplace for Information in Critical Care Medicine (MIMIC-IV) database. Univariate and multivariate logistic regression models are employed to explore the correlation between serum bicarbonate levels and the risk of POD, and their predictive efficacy is assessed by means of restricted cubic spline regression models (RCS) and receiver operating characteristic curves (ROC). In addition, subgroup and sensitivity analyses are conducted to test the robustness of the results.

RESULTS

In this study, 5,422 patients were included, where the incidence of POD was 13.0%. For each 1 mmol/L increase in bicarbonate, a 13% reduction in the risk of POD was observed in the fully adjusted model (OR = 0.87, 95% CI: 0.83-0.91, P < 0.001). The RCS model demonstrated a linear negative correlation between the level of bicarbonate and the risk of POD (P for nonlinearity = 0.987). The ROC curve analysis demonstrated that the bicarbonate level had moderate predictive efficacy (AUC = 0.629). Both subgroup and sensitivity analyses reaffirmed the robustness of these results.

CONCLUSIONS

Lower baseline serum bicarbonate levels in cardiac surgery patients are linked to a higher risk of POD. Monitoring and adjusting serum bicarbonate levels may help identify high-risk patients and potentially improve outcomes.

A nomogram to predict 28-day mortality in neonates with sepsis: a retrospective study based on the MIMIC-III database

Background

Sepsis is the second-leading cause of death in neonates. We established a predictive nomogram to identify critically ill neonates early and reduce the time to treatment.

Methods

It is a retrospective case-control study based on the MIMIC-III database. The study population comprised 924 neonates diagnosed with sepsis.

Results

Neonates with sepsis included in the MIMIC-III database were enrolled, including 880 surviving neonates and 44 neonates who died. In the derivation dataset, stepwise regression and the Lasso algorithm were employed to select predictive variables, and the neonatal sequential organ failure assessment score (nSOFA) was calculated simultaneously. Bootstrap resampling was utilized to perform internal validation. The results indicated that the Lasso algorithm displayed superior discrimination, sensitivity, and specificity relative to stepwise regression and nSOFA scores. After 500 bootstrap resampling tests, the area under the receiver operating characteristic curve (AUC) of the Lasso algorithm was 0.912 (95% CI: 0.870-0.977). The nomogram based on the Lasso algorithm outperformed stepwise regression and nSOFA scores in terms of calibration and the clinical net benefit. This nomogram can assist in prognosticating neonatal severe sepsis and aid in guiding clinical practice while concurrently improving patient outcomes.

Conclusions

The established nomogram revealed that jaundice, corticosteroid use, weight, serum calcium, inotropes and base excess are all important predictors of 28-day mortality in neonates with sepsis. This nomogram can facilitate the early identification of neonates with severe sepsis. However, it still requires further modification and external validation to make it widely available.

Predictive value of admission CO2 combining power combined with serum sodium for the prognosis in acute Stanford type A aortic dissection patients

Acute Stanford type A aortic dissection (ATAAD) with sudden onset and high mortality requiries a standard Bentall operation and a accurate prognosis in common, together with alteration of CO₂ combining power (CO₂CP) and serum sodium rase concern, hence, we evaluated the prognostic value of CO₂CP combined with serum sodium in ATAAD patients. This retrospective study included 183 patients who underwent Bentall operation for ATAAD from 2015 to 2021 in the Fourth Hospital of Hebei Medical University, subsequently followed grouping by the levels of CO₂CP and serum sodium. The study endpoint was 30-day all-cause mortality, and the prognostic value of CO₂CP combined with serum sodium levels in ATAAD patients were evaluated with multivariate logistic regression method. The postoperative incidence of in-hospital death and adverse events in patients with ATAAD were 18% and 25.7%, respectively. Combination of CO₂CP and serum sodium for predicting ATAAD death and adverse events presented a higher predictive value than each single indicator with ROC curve analysis (the AUC of CO₂CP combined with serum sodium was 0.786, 95% CI 0.706-0.869, P < 0.001), along with CO₂CP < 22.5 mmol/L + serum sodium > 138.5 mmol/L group had the worst prognostic. Multivariate regression analyse showed that CO₂CP < 22.5 mmol/L combined with serum sodium > 138.5 mmol/L preferably predicted the prognosis of ATAAD (OR =6.073, 95% CI 2.557-14.425, P < 0.001). Consistently, the cumulative 30-day survival after surgery in ATAAD patients with the low CO₂CP and high serum sodium simultaneously was the worst (log-rank P < 0.05). The combination of CO₂CP and serum sodium increases the predictive value of prognosis, which is conducive to risk stratification of patients with ATAAD.

Development and validation of a simple nomogram for predicting the short-term prognosis of patients with pulmonary embolism

BACKGROUND

Pulmonary embolism (PE) is a disease caused by blood clots, tumor embolism, and other emboli within the pulmonary arteries. Various scoring scales are used for PE. One such same is the PESI, but it has 12 variables, making it inconvenient for clinical application.

OBJECTIVES

The aim of this study was to develop a new simple nomogram model to assess 30-day survival in PE patients. The new nomogram makes it easier and faster for clinicians to assess the prognosis of patients with PE.

METHODS

We collected data about the patients with PE from the Medical Information Mart for Intensive Care-III (MIMIC-III) database and used the receiver operating characteristic (ROC) curve, area under the ROC curve (AUROC), calibration plot, integrated discrimination improvement (IDI), and decision curve analysis (DCA) to evaluate the predictive power of the new model, and compared these with the PESI.

RESULTS

According to the multivariable Cox regression model results, alongside the actual clinical conditions, we included the following seven variables: race, bicarbonate, age, tumor, systolic blood pressure (SBP), body temperature, and oxygen saturation (Spo2). The AUROC of the new model was greater than 0.70. Its IDI exceeded 0, but with P-value>0.05.

CONCLUSION

The predictive performance of the new model was not worse than the PESI, but the new model only has seven variables, and is therefore more convenient for clinicians to use.

Association of lactate to albumin ratio and bicarbonate with short-term mortality risk in patients with acute myocardial infarction

BACKGROUND

Previous studies have indicated that the ratio of lactate/albumin (L/A) has predictive value for the prognosis of critically ill patients with heart failure. Some studies have also indicated that a low serum bicarbonate concentration is inversely related to the mortality risk of patients with cardiogenic shock. However, the value of bicarbonate and the L/A ratio for predicting the mortality risk of patients with acute myocardial infarction (AMI) is still unclear. We therefore conducted a retrospective study to research this problem.

METHODS

The subjects of this study were patients with AMI, and the data source was the Medical Information Mart for Intensive Care III database. The primary endpoint was 30-day all-cause mortality after admission. The Receiver operating characteristic (ROC) curve was used to compare the predictive value of L/A ratio, lactate and albumin for end-point events. The effects of different L/A ratio levels and different bicarbonate concentrations on 7-day and 30-day all-cause mortality were compared using Kaplan-Meier (K-M) curves. Hazard ratios for different L/A ratio and different bicarbonate concentrations were investigated using COX proportional hazards models.

RESULTS

The Area Under Curve (AUC) of L/A ratio, lactate, and albumin were 0.736, 0.718, and 0.620, respectively. (1) L/A ratio: The patients were divided into three groups according to their L/A ratio: tertile T1 (L/A ratio ≤ 0.47), tertile T2 (L/A ratio ≤ 0.97), and tertile T3 (L/A ratio > 0.97). The T2 and T3 groups had higher 30-day all-cause mortality risks than the T1 group. The restricted cubic spline (RCS) model indicated that there was a nonlinear relationship between L/A ratio and 30-day mortality (P < 0.05). (2) Bicarbonate concentration: The patients were also divided into three groups based on their bicarbonate concentration: G1 (22-27 mmol/L), G2 (< 22 mmol/L), and G3 (> 27 mmol/L). The G2 and G3 groups had higher 30-day all-cause mortality risks than the G1 group. The RCS model indicated that there was a nonlinear relationship between bicarbonate concentration and 30-day mortality (P < 0.05). The RCS model indicated that there was a nonlinear relationship between hemoglobin level and 30-day all-cause mortality (P < 0.05).

CONCLUSION

L/A ratio and bicarbonate concentration and hemoglobin level have predictive value for predicting 30-day mortality in patients with acute myocardial infarction.