Associations of the Serum Total Carbon Dioxide Level with Long-Term Clinical Outcomes in Sepsis Survivors.

ABSTRACT

INTRODUCTION: Sepsis is characterized by a dysregulated host response to infection that leads to multiple organ dysfunction and often complicated with metabolic acidosis. However, the associations between serum total carbon dioxide level (TCO2) and long-term clinical outcomes in sepsis survivors remains unknown. METHODS: A total of 7212 sepsis survivors aged ≥ 20 years who were discharged from January  1, 2008 to December 31, 2018 were included in our analyses. The sepsis survivors were further divided into high TCO2 (≥ 18 mmol/L) and low TCO2 (< 18 mmol/L) groups, comprising 5023 and 2189 patients, respectively. The following outcomes of interest were included all-cause mortality, myocardial infarction, ischemic stroke, hospitalization for heart failure, ventricular arrhythmia, and end-stage renal disease (ESRD). RESULTS: After propensity score matching, the low TCO2 group was at higher risks of all-cause mortality (hazard ratio [HR] 1.28, 95% confidence interval [95% CI] 1.18-1.39), myocardial infarction (HR 1.83, 95% CI 1.39-2.43), and ESRD (HR 1.38, 95% CI 1.16-1.64) than the high TCO2 group. The results remained similar after considering death as a competing risk. CONCLUSION: Patients discharged from hospitalization for sepsis have higher risks of worse long-term clinical outcomes. Physicians may need to pay more attention to sepsis survivors whose TCO2 was low.