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Background <p>Sepsis often leads to acute organ dysfunction and significantly increases the risk of mortality, frequently occurring alongside acute kidney injury, termed sepsis-associated acute kidney injury (Sa-AKI). This study aimed to assess whether base excess (BE) is associated with mortality in Sa-AKI patients within the intensive care unit (ICU).</p> Methods <p>Data were extracted from a US ICU cohort. BE served as the exposure variable, and 30-day and 90-day ICU all-cause mortality were the outcomes of interest. Multivariate Cox proportional hazards models were performed to assess the associations of BE and mortality outcomes of interest among Sa-AKI patients. Furthermore, multivariate restricted cubic spline (RCS) analyses were used to investigate potential nonlinear relationships between BE and outcomes of interest.</p> Result <p>10,812 Sa-AKI patients were included, RCS analyses demonstrated a non-linear relationship between BE and the risk of mortality for both 30-day and 90-day ICU mortality. Multivariate Cox proportional hazards models indicated that higher BE groups had a decreased risk of 30-day (Q3: HR 0.79, 95%CI 0.69–0.91; Q4: HR 0.82, 95%CI 0.73–0.93), 90-day ICU all-cause mortality (Q3: HR 0.81, 95%CI 0.72–0.91; Q4: HR 0.84, 95%CI 0.75–0.94) compared with the lowest BE group. Based on RCS analysis, patients were regrouped by BE values (Group 1: ≤ − 4&#xa0;mmol/L, Group 2: − 4 to 7&#xa0;mmol/L, Group 3: ≥ 7&#xa0;mmol/L) for Kaplan–Meier survival analysis. Group 2 had the lowest 30-day and 90-day ICU mortality rate (log-rank<i> P</i> &lt; 0.0001).</p> Conclusion <p>In ICU patients with Sa-AKI, there is a non-linear relationship between BE levels and 30-day and 90-day all-cause mortality. A moderate BE range (− 4 to 7&#xa0;mmol/L) is associated with a protective effect, whereas both excessively high and low BE levels increase mortality risk.</p>

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Impact of base excess on mortality in patients with sepsis-associated acute kidney injury: insights from US Intensive Care Unit Cohort

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2025年7月17日

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  • Lin Liu,
  • Hu Liu,
  • Yang Chen,
  • Ling-long Wang,
  • Yan-bo Zhao,
  • You-en Zhang

摘要

Background

Sepsis often leads to acute organ dysfunction and significantly increases the risk of mortality, frequently occurring alongside acute kidney injury, termed sepsis-associated acute kidney injury (Sa-AKI). This study aimed to assess whether base excess (BE) is associated with mortality in Sa-AKI patients within the intensive care unit (ICU).

Methods

Data were extracted from a US ICU cohort. BE served as the exposure variable, and 30-day and 90-day ICU all-cause mortality were the outcomes of interest. Multivariate Cox proportional hazards models were performed to assess the associations of BE and mortality outcomes of interest among Sa-AKI patients. Furthermore, multivariate restricted cubic spline (RCS) analyses were used to investigate potential nonlinear relationships between BE and outcomes of interest.

Result

10,812 Sa-AKI patients were included, RCS analyses demonstrated a non-linear relationship between BE and the risk of mortality for both 30-day and 90-day ICU mortality. Multivariate Cox proportional hazards models indicated that higher BE groups had a decreased risk of 30-day (Q3: HR 0.79, 95%CI 0.69–0.91; Q4: HR 0.82, 95%CI 0.73–0.93), 90-day ICU all-cause mortality (Q3: HR 0.81, 95%CI 0.72–0.91; Q4: HR 0.84, 95%CI 0.75–0.94) compared with the lowest BE group. Based on RCS analysis, patients were regrouped by BE values (Group 1: ≤ − 4 mmol/L, Group 2: − 4 to 7 mmol/L, Group 3: ≥ 7 mmol/L) for Kaplan–Meier survival analysis. Group 2 had the lowest 30-day and 90-day ICU mortality rate (log-rank P < 0.0001).

Conclusion

In ICU patients with Sa-AKI, there is a non-linear relationship between BE levels and 30-day and 90-day all-cause mortality. A moderate BE range (− 4 to 7 mmol/L) is associated with a protective effect, whereas both excessively high and low BE levels increase mortality risk.