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Relationship of at Admission Lactate, Unmeasured Anions, and Chloride to the Outcome of Critically Ill Patients

Masevicius, Fabio Daniel MD1; Rubatto Birri, Paolo Nahuel MD2; Risso Vazquez, Alejandro MD2; Zechner, Facundo Emanuel MD2; Motta, María Fernanda MD2; Valenzuela Espinoza, Emilio Daniel MD2; Welsh, Sebastián MD2; Guerra Arias, Ernesto Fidel MD2; Furche, Mariano Andrés MD2; Berdaguer, Fernando Daniel MD2; Dubin, Arnaldo MD, PhD2

doi: 10.1097/CCM.0000000000002730
Online Clinical Investigations
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Objectives: To investigate the association between the concentration of the causative anions responsible for the main types of metabolic acidosis and the outcome.

Design: Prospective observational study.

Setting: Teaching ICU.

Patients: All patients admitted from January 2006 to December 2014.

Interventions: None.

Measurements and Main Results: Four thousand nine hundred one patients were admitted throughout the study period; 1,609 met criteria for metabolic acidosis and 145 had normal acid-base values. The association between at admission lactate, unmeasured anions, and chloride concentration with outcome was assessed by multivariate analysis in the whole cohort and in patients with metabolic acidosis. We also compared the mortality of patients with lactic, unmeasured anions, and hyperchloremic metabolic acidosis with that of patients without acid-base disorders. In the whole population, increased lactate and unmeasured anions were independently associated with increased mortality, even after adjusting for potential confounders (odds ratio [95% CI], 1.14 (1.08–1.20); p < 0.0001 and 1.04 (1.02–1.06); p < 0.0001, respectively). In patients with metabolic acidosis, the results were similar. Patients with lactic and unmeasured anions acidosis, but not those with hyperchloremic acidosis, had an increased mortality compared to patients without alterations (17.7%, 12.7%, 4.9%, and 5.8%, respectively; p < 0.05).

Conclusions: In this large cohort of critically ill patients, increased concentrations of lactate and unmeasured anions, but not chloride, were associated with increased mortality. In addition, increased unmeasured anions were the leading cause of metabolic acidosis.

Supplemental Digital Content is available in the text.

1Servicio de Terapia Intensiva, Sanatorio de la Trinidad Ramos Mejía, Ramos Mejía, Argentina.

2Servicio de Terapia Intensiva, Sanatorio Otamendi y Miroli, Buenos Aires, Argentina.

This work was performed in Servicio de Terapia Intensiva, Sanatorio Otamendi y Miroli, Buenos Aires, Argentina.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal’s website (http://journals.lww.com/ccmjournal).

Supported, in part, by Institutional funds.

The authors have disclosed that they do not have any potential conflicts of interest.

For information regarding this article, E-mail: arnaldodubin@gmail.com

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