Effectiveness of Sodium Bicarbonate Infusion on Mortality in Critically Ill Children With Metabolic Acidosis

Wang, Huabin; Rui, Liang; Liang, Tianqi; Chen, Songyao; Zhang, Lidan; Chen, Chun

doi:10.3389/fphar.2022.759247

Cited by 7 publications

(7 citation statements)

References 26 publications

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“…In addition, based on curve analysis, we showed that the in-hospital mortality rate of the two groups of children with or without SB treatment gradually decreased with increases in the pH and HCO3concentration, but there was no signi cant difference in the inhospital mortality rate of the pH and HCO3concentration between patients with or without SB treatment. Based on the above results, we believe that although acidosis is associated with patient outcomes, SB treatment does not improve the overall outcome of patients in the PICU, which is in agreement to the results of other studies [10][11][12][13].…”

Section: Discussionsupporting

confidence: 91%

“…Based on the real-world PICU database, we successfully showed that the in uencing factor, chloride concentration, affects the clinical outcome of metabolic acidosis in the treatment of SB. Similar studies used binary grouping, prior matching, or local subgroups to compare data [10,13,26]. Such an analysis method lacks a comprehensive exploration of the data, making it di cult to identify key factors.…”

Section: Discussionmentioning

confidence: 99%

“…In adults with severe metabolic acidemia, SB treatment has no effect on mortality or the SOFA score [9]. Similarly, data from studies in children have shown that SB treatment does not improve outcomes in children [10,11]. SB treatment, however, can reduce organ damage and the 28-day mortality rate in AKI patients, reducing the need for renal replacement therapy [12][13][14].…”

Section: Introductionmentioning

confidence: 99%

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Clinical outcomes of sodium bicarbonate therapy in critically ill pediatric patients with metabolic acidosis are associated with chloride

Liu¹,

Cao

Xue

et al. 2022

Preprint

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Background: Metabolic acidosis is a common acid-base imbalance in critically ill patients. Whether sodium bicarbonate (SB) can improve clinical outcomes in the treatment of metabolic acidosis is still controversial. The aim of this study was to determine the factors influencing the clinical efficacy of SB in the treatment of metabolic acidosis and the potential benefit to patients. Methods: Patients with metabolic acidosis who were treated with or without SB were identified and grouped from a retrospective cohort (Pediatric Intensive Care Unit [PICU] database), from which the clinical data were extracted. The in-hospital mortality curves of the acid-base balance parameters of patients in the two groups were drawn and fitted using the locally-weighted scatter plot smoothing (LOWESS) method. The prevalence ratios (PRs) of in-hospital mortality were estimated by log-binomial regression based on the maximum likelihood method, and the potential confounders, such as age and disease category, were adjusted. Results: A total of 6,167 children with metabolic acidosis were enrolled, of whom 2,626 (42.58%) were treated with SB. The overall analysis showed that there was no significant difference in the in-hospital mortality rates (9.71% vs. 10.56%, p = 0.275) between children in the SB treatment and non-treatment groups, adjusted PR = 0.929 (95% CI, 0.802-1.072). There was no significant difference in the in-hospital mortality rates as a function of pH and HCO3- between the two groups. The in-hospital mortality rate as a function of chloride was significantly different; specifically, the curve of the untreated group was U-shaped and the curve of the treated group was L-shaped. The curves of the two groups crossed at 110 mmol/L of chloride after LOWESS fitting. There was no statistically significant difference in the risk of death between the SB treatment and non-treatment groups at a chloride < 107 mmol/L and a chloride >113 mmol/L. In the chloride < 107 mmol/L subgroup, SB treatment had a 41.7% increased risk of in-hospital death (adjusted PR=1.417, 95% CI, 1.069−1.481) and a 35.9% increased risk of 28-day death (adjusted PR=1.359, 95% CI, 1.315−1.474). In the chloride≥113 mmol/L subgroup, SB treatment had a 61.1% reduced risk of in-hospital death (adjusted PR=0.389, 95% CI, 0.268−0.553) and a 56.4% reduced risk of 28-day death (adjusted PR=0.436, 95% CI, 0.295−0.631). The median length of stay in the PICU of children in the SB group was also shorter than children in the non-treatment group when the chloride concentration was ≥110 mmol/L. Conclusions: The clinical outcomes of SB in the treatment of metabolic acidosis are associated with chloride. When the chloride concentration was high (> 110 mmol/L), children benefited from SB treatment and when the chloride concentration was low (< 107 mmol/L), the risk of death increased.

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Section: Discussionsupporting

confidence: 91%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Clinical outcomes of sodium bicarbonate therapy in critically ill pediatric patients with metabolic acidosis are associated with chloride

Liu¹,

Cao

Xue

et al. 2022

Preprint

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“…In previous studies, binary grouping, matching, or local subgroups were commonly utilized for comparative analyses of data [ 10 , 13 , 26 ]. However, these analytical methods are limited because they do not comprehensively explore the data information, making it difficult to identify factors that affect the clinical efficacy of SB.…”

Section: Discussionmentioning

confidence: 99%

Clinical efficacy of sodium bicarbonate in treating pediatric metabolic acidosis with varying level of acid–base balance parameters: a real-world study

Liu,

Cao,

Xue

et al. 2023

BMC Med

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Background Sodium bicarbonate (SB) infusion is commonly used to correct metabolic acidosis, but its clinical efficacy remains controversial. This study aims to investigate whether acid–base balance parameters should be a consideration for administering SB treatment. Methods Children with metabolic acidosis (pH < 7.35 and bicarbonate < 22 mmol/L) who were treated with or without 50 mg/ml SB injection were grouped and extracted from a retrospective cohort database of the Pediatric Intensive Care Unit. The interaction between acid–base balance parameters and SB treatment on mortality was analyzed through mortality curves and cross-effect models. Logistic regression was conducted to estimate the risk of death following SB treatment in the overall children as well as in subgroups, and potential confounding factors were adjusted for. After employing propensity score matching to account for confounding factors, further analysis was performed to evaluate the effectiveness of SB treatment within each chloride subgroup. Results A total of 5865 children with metabolic acidosis were enrolled, of which 2462 (42.0%) received SB treatment. In the overall population, it was found that SB treatment did not reduce hospital mortality or 28-day mortality. Interactions between acid–base balance parameters (chloride and anion gap) and SB treatment on mortality were observed. Subgroup analysis clarified that when chloride levels were below 107 mmol/L, children treated with SB had higher in-hospital mortality (29.8% vs 14.9%) and 28-day mortality (26.5% vs 13.4%), with adjusted ORs of 2.065 (95% CI, 1.435–2.97) and 1.947 (95% CI, 1.332–2.846), respectively. In contrast, when chloride levels were greater than or equal to 113 mmol/L, children treated with SB had a shorter stay in the PICU (median: 1.1 days vs 5.1 days, adjusted p = 0.004) and lower in-hospital mortality (4.3% vs 10.3%) and 28-day mortality (4.0% vs 8.4%), with adjusted ORs of 0.515 (95% CI, 0.337–0.788) and 0.614 (95% CI, 0.391–0.965), respectively. After controlling for confounding factors through matching, the impact of SB treatment on the risk of death in each chloride subgroup was consistent with the aforementioned results. However, treatment with SB did not significantly increase the risk of death in newborns or children with moderate to severe metabolic acidosis when chloride levels were below 107 mmol/L (p > 0.05). Conclusions The use of sodium bicarbonate for treating metabolic acidosis has been found to increase mortality in children with low chloride levels but decrease mortality in those with high chloride levels in this study. Further prospective multi-center clinical studies and basic research are needed to validate these findings.

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“…Hence, it is recommended to focus on treating the causes of metabolic acidosis rather than sodium bicarbonate infusion. 17 In their study, Takia et al, emphasized the need for a properly conducted trial to determine the role of IV soda bicarbonate therapy in treating severe acidosis, especially the NAGMA component, during the management of patients suffering from acute diarrhea and severe dehydration. Evidence-based guidelines on correcting metabolic acidosis and the indications of bicarbonate therapy may help critically ill pediatric patients.…”

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confidence: 99%

Normal Anion Gap Metabolic Acidosis in Pediatric Acute Diarrhea: A Menace or an Innocent Bystander?

Bhowmick¹

2022

Indian Journal of Critical Care Medicine

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Effectiveness of Sodium Bicarbonate Infusion on Mortality in Critically Ill Children With Metabolic Acidosis

Cited by 7 publications

References 26 publications

Clinical outcomes of sodium bicarbonate therapy in critically ill pediatric patients with metabolic acidosis are associated with chloride

Clinical outcomes of sodium bicarbonate therapy in critically ill pediatric patients with metabolic acidosis are associated with chloride

Clinical efficacy of sodium bicarbonate in treating pediatric metabolic acidosis with varying level of acid–base balance parameters: a real-world study

Normal Anion Gap Metabolic Acidosis in Pediatric Acute Diarrhea: A Menace or an Innocent Bystander?

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