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J Crit Care. 2016 Feb;31(1):243-8. doi: 10.1016/j.jcrc.2015.09.025. Epub 2015 Oct 5.

Prognosis of patients presenting extreme acidosis (pH <7) on admission to intensive care unit.

Author information

1
Intensive Care Unit, CHU Félix Guyon, La Réunion, Bellepierre 97405 Saint-Denis Cedex, France. Electronic address: allyn.jer@gmail.com.
2
Intensive Care Unit, CHU Félix Guyon, La Réunion, Bellepierre 97405 Saint-Denis Cedex, France.
3
Biology Laboratory, CHU Félix Guyon, La Réunion, Bellepierre 97405 Saint-Denis cedex, France.

Abstract

PURPOSE:

The purpose was to determine prognosis of patients presenting extreme acidosis (pH <7) on admission to the intensive care unit (ICU) and to identify mortality risk factors.

MATERIALS AND METHODS:

We retrospectively analyzed all patients who presented with extreme acidosis within 24 hours of admission to a polyvalent ICU in a university hospital between January 2011 and July 2013. Multivariate analysis and survival analysis were used.

RESULTS:

Among the 2156 patients admitted, 77 patients (3.6%) presented extreme acidosis. Thirty (39%) patients suffered cardiac arrest before admission. Although the mortality rate predicted by severity score was 93.6%, death occurred in 52 cases (67.5%) in a median delay of 13 (5-27) hours. Mortality rate depended on reason for admission, varying between 22% for cases linked to diabetes mellitus and 100% for cases of mesenteric infarction (P = .002), cardiac arrest before admission (P < .001), type of lactic acidosis (P = .007), high Simplified Acute Physiology Score II (P = .008), and low serum creatinine (P = .012).

CONCLUSIONS:

Patients with extreme acidosis on admission to ICU have a less severe than expected prognosis. Whereas mortality is almost 100% in cases of cardiac arrest before admission, mortality is much lower in the absence of cardiac arrest before admission, which justifies aggressive ICU therapies.

KEYWORDS:

Acidosis; Lactate; Prognosis

PMID:
26507640
DOI:
10.1016/j.jcrc.2015.09.025
[Indexed for MEDLINE]

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