Origen de la acidosis metabólica según los determinantes del déficit de base en pacientes con choque séptico como factor de riesgo para mortalidad

Abstract

Introduction: In patients with septic shock, metabolic acidosis is the most frequent acid-base disorder and the main causative ion will determine the prognosis in this group of patients. Studies have focused on the estimation of lactate to determine the prognosis, although today we know that metabolic acidosis in these patients may be caused by the effect not only of lactate but also by the effect of water, effect of chlorine, effect of albumin and effect of unmeasured anions. Material and methods: A cohort study was performed, ambispective, longitudinal, descriptive and analytical. In patients diagnosed with septic shock and metabolic acidosis, admitted to the Intensive Care Unit (ICU) in the period from June 15, 2015 to July 30, 2018. The risk for mortality of the variables was evaluated: lactate, the effect of water, the effect of chlorine, the effect of albumin and the effect of unmeasured anions. All statistical analyzes were performed with the SPSSTM 22.0 program. Results: In the period considered, 87 patients met the inclusion criteria, of which 46% were male and 54% were female. 44.8% of patients died during their stay. In the multivariate analysis, the variables with statistical significance, measures at admission as a risk factor for mortality were: the effect of water with cut-off point > -0.75 mEq/L, presents an OR 7.227 (CI95%: 1.831-28.5; p = 0.005), the effect of albumin with cut-off point of > -4.75 mEq/L, presents an OR 6.163 (CI95%: 1.786-21.2, p = 0.004). Conclusion: Metabolic acidosis goes beyond the addition or removal of solutes, the dissociation of water having great importance.