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Alkalosis in Critically III Patients with Severe Sepsis and Septic Shock
Lund University, Sweden; Örebro University Hospital, Sweden.
Lund University, Sweden; Västmanland County Hospital, Sweden.
Lund University, Sweden.
Gothenburg University, Sweden.
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2017 (English)In: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 12, no 1, article id e0168563Article in journal (Refereed) Published
Abstract [en]

Introduction Although metabolic alkalosis is a common occurrence in intensive care units (ICUs), no study has evaluated its prevalence or outcomes in patients with severe sepsis or septic shock. Methods This is a retrospective cohort study of critically ill patients suffering from severe sepsis and septic shock admitted to the ICUs of Halmstad and Varberg County hospitals. From 910 patient records, 627 patients met the inclusion criteria. We investigated the relationship between metabolic alkalosis and mortality. Further, we studied the relationship between metabolic alkalosis and ICU length of stay (LOS). Results Metabolic alkalosis was associated with decreased 30-day and 12-month mortalities. This effect was however lost when a multivariate analysis was conducted, correcting for age, gender, pH on admission, base excess (BE) on admission, Simplified Acute Physiology Score III (SAPS III) and acute kidney injury (AKI). We then analyzed for any dose-response effect between the severity of metabolic alkalosis and mortality and found no relationship. Bivariate analysis showed that metabolic alkalosis had a significant effect on the length of ICU stay. When adjusting for age, sex, pH at admission, BE at admission, SAPS III and AKI in a multivariate analysis, metabolic alkalosis significantly contributed to prolonged ICU length of stay. In two separate sensitivity analyses pure metabolic alkalosis and late metabolic alkalosis (time of onset amp;gt; 48 hours) were the only significant predictor of increased ICU length of stay. Conclusion Metabolic alkalosis did not have any effect on 30-day and 12-month mortalities after adjusting for age, sex, SAPS III-score, pH and BE on admission and AKI in a multivariate analysis. The presence of metabolic alkalosis was independently associated with an increased ICU length of stay.

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PUBLIC LIBRARY SCIENCE , 2017. Vol. 12, no 1, article id e0168563
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Anesthesiology and Intensive Care
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URN: urn:nbn:se:liu:diva-134483DOI: 10.1371/journal.pone.0168563ISI: 000391612300033PubMedID: 28045915OAI: oai:DiVA.org:liu-134483DiVA, id: diva2:1074429
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Funding Agencies|Region Halland County Council [RS147]

Available from: 2017-02-15 Created: 2017-02-15 Last updated: 2017-11-29

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Chew, Michelle
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Division of Drug ResearchFaculty of Medicine and Health SciencesDepartment of Anaesthesiology and Intensive Care in Linköping
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