Association Between Base Excess and Mortality Among Patients in ICU With Acute Kidney Injury

Yi Cheng; You Zhang; Boxiang Tu; Yingyi Qin; Xin Cheng; Ran Qi; Wei Guo; Dongdong Li; Shengyong Wu; Ronghui Zhu; Yanfang Zhao; Yuanjun Tang; Cheng Wu

doi:10.3389/fmed.2021.779627

Association Between Base Excess and Mortality Among Patients in ICU With Acute Kidney Injury

Front Med (Lausanne). 2021 Dec 2:8:779627. doi: 10.3389/fmed.2021.779627. eCollection 2021.

Authors

Yi Cheng¹, You Zhang², Boxiang Tu¹, Yingyi Qin¹, Xin Cheng³, Ran Qi⁴, Wei Guo¹, Dongdong Li¹, Shengyong Wu¹, Ronghui Zhu¹, Yanfang Zhao¹, Yuanjun Tang⁵, Cheng Wu¹

Affiliations

¹ Department of Military Health Statistics, Naval Medical University, Shanghai, China.
² Department of Nephrology, Changhai Hospital, Naval Medical University, Shanghai, China.
³ Jinan People's Hospital Affiliated to Shandong First Medical University, Shandong, China.
⁴ The Second Children & Women's Healthcare of Jinan City, Shandong, China.
⁵ Department of Clinical Pharmacy, Shanghai General Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China.

Abstract

Objective: This study aimed to explore the association between base excess (BE) and the risk of 30-day mortality among patients with acute kidney injury (AKI) in the intensive care unit (ICU). Methods: This retrospective study included patients with AKI from the Medical Information Mart for Intensive Care (MIMIC)-IV database. We used a multivariate Cox proportional-hazards model to obtain the hazard ratio (HR) for the risk of 30-day mortality among patients with AKI. Furthermore, we utilized a Cox proportional-hazard model with restricted cubic splines (RCS) to explore the potential non-linear associations. Results: Among the 14,238 ICU patients with AKI, BE showed a U-shaped relationship with risk of 30-day mortality for patients with AKI, and higher or lower BE values could increase the risk. Compared with normal base excess (-3~3 mEq/L), patients in different groups (BE ≤ -9 mEq/L, -9 mEq/L < BE ≤ -3 mEq/L, 3 mEq/L < BE ≤ 9 mEq/L, and BE > 9 mEq/L) had different HRs for mortality: 1.57 (1.40, 1.76), 1.26 (1.14, 1.39), 0.97 (0.83, 1.12), 1.53 (1.17, 2.02), respectively. The RCS analyses also showed a U-shaped curve between BE and the 30-day mortality risk. Conclusion: Our results suggest that higher and lower BE in patients with AKI would increase the risk of 30-day mortality. BE measured at administration could be a critical prognostic indicator for ICU patients with AKI and provide guidance for clinicians.

Keywords: 30-day mortality; MIMIC-IV; acute kidney injury; base excess; restrict cubic splines.