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Am J Surg. 2017 Dec;214(6):1067-1072. doi: 10.1016/j.amjsurg.2017.08.033. Epub 2017 Sep 18.

Returning from the acidotic abyss: Mortality in trauma patients with a pH < 7.0.

Author information

1
Division of Acute Care Surgery, Department of Surgery, Carolinas Medical Center, Charlotte, NC, USA. Electronic address: Samuel.Ross@carolinashealthcare.org.
2
Division of Acute Care Surgery, Department of Surgery, Carolinas Medical Center, Charlotte, NC, USA. Electronic address: Bradley.Thomas@carolinashealthcare.org.
3
Division of Acute Care Surgery, Department of Surgery, Carolinas Medical Center, Charlotte, NC, USA. Electronic address: Ashley.Christmas@carolinashealthcare.org.
4
Division of Acute Care Surgery, Department of Surgery, Carolinas Medical Center, Charlotte, NC, USA. Electronic address: Kyle.Cunningham@carolinashealthcare.org.
5
Division of Acute Care Surgery, Department of Surgery, Carolinas Medical Center, Charlotte, NC, USA. Electronic address: Ronald.Sing@carolinashealthcare.org.

Abstract

INTRODUCTION:

We hypothesized that a pH of <7.0 on presentation would correlate with almost universal mortality in trauma patients.

METHODS:

A retrospective cohort study was performed on a Level I trauma center registry from 2013 to 2014. Hospital mortality was the primary outcome, which was compared by pH cohort (<7.0 or ≥7.0) using standard univariate statistics and multivariate logistic regression.

RESULTS:

There were 593 patients included in the analysis: 66 in <7.0, 527 in ≥7.0. Mortality was 3× higher in the <7.0 pH cohort (62.1 vs. 20.3%; p < 0.0001), however there was no threshold for a pH below which there was 100% mortality. After controlling for these confounding variables, initial pH was found to be an independent predictor of inpatient mortality: pH < 7.0 (OR 6.33, 3.29-12.19; p < 0.0001).

CONCLUSION:

This data indicates that while patients with severe acidosis are at increased risk for mortality, a pH < 7.0 is still recoverable in select cases.

KEYWORDS:

Acidosis; Futility; Mortality; Trauma; pH < 7.0

PMID:
29079021
DOI:
10.1016/j.amjsurg.2017.08.033
[Indexed for MEDLINE]

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