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


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.
Intensive Care Unit, CHU Félix Guyon, La Réunion, Bellepierre 97405 Saint-Denis Cedex, France. Electronic address: allyn.jer@gmail.com.
Jérôme
J
Allyn
Intensive Care Unit, CHU Félix Guyon, La Réunion, Bellepierre 97405 Saint-Denis Cedex, France.
David
D
Vandroux
Intensive Care Unit, CHU Félix Guyon, La Réunion, Bellepierre 97405 Saint-Denis Cedex, France.
Julien
J
Jabot
Intensive Care Unit, CHU Félix Guyon, La Réunion, Bellepierre 97405 Saint-Denis Cedex, France.
Caroline
C
Brulliard
Intensive Care Unit, CHU Félix Guyon, La Réunion, Bellepierre 97405 Saint-Denis Cedex, France.
Richard
R
Galliot
Intensive Care Unit, CHU Félix Guyon, La Réunion, Bellepierre 97405 Saint-Denis Cedex, France.
Xavier
X
Tabatchnik
Biology Laboratory, CHU Félix Guyon, La Réunion, Bellepierre 97405 Saint-Denis cedex, France.
Patrice
P
Combe
Intensive Care Unit, CHU Félix Guyon, La Réunion, Bellepierre 97405 Saint-Denis Cedex, France.
Olivier
O
Martinet
Intensive Care Unit, CHU Félix Guyon, La Réunion, Bellepierre 97405 Saint-Denis Cedex, France.
Nicolas
N
Allou
D000138:Acidosis / Q000401:mortality; D000140:Acidosis, Lactic / Q000139:chemically induced / Q000401:mortality / Q000628:therapy*; D000142:Acidosis, Respiratory / Q000401:mortality / Q000628:therapy*; D000328:Adult; D000368:Aged; D003920:Diabetes Mellitus / Q000188:drug therapy / Q000453:epidemiology; D015199:Extracorporeal Membrane Oxygenation; D005260:Female; D006323:Heart Arrest / Q000453:epidemiology; D006470:Hemorrhage / Q000453:epidemiology; D017052:Hospital Mortality; D006760:Hospitalization; D006785:Hospitals, University; D006801:Humans; D007004:Hypoglycemic Agents / Q000009:adverse effects; D007238:Infarction / Q000453:epidemiology; D007362:Intensive Care Units; D008297:Male; D065666:Mesenteric Ischemia / Q000453:epidemiology; D008687:Metformin / Q000009:adverse effects; D008875:Middle Aged; D015999:Multivariate Analysis; D011379:Prognosis; D006435:Renal Dialysis; D012121:Respiration, Artificial; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D017693:Sodium Bicarbonate / Q000627:therapeutic use*; D016019:Survival Analysis; D014662:Vasoconstrictor Agents / Q000627:therapeutic use*
D007004:Hypoglycemic Agents; D014662:Vasoconstrictor Agents; D017693:Sodium Bicarbonate; D008687:Metformin
Acidosis; Lactate; Prognosis