• Jin Hee Kim, Dong-Hyun Jang, You Hwan Jo, Gil Joon Suh, Woon Yong Kwon, Jae Hyuk Lee, Jonghwan Shin, Inwon Park, Che Uk Lee, and Sang-Min Lee.
• Department of Emergency Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea.
• Am J Emerg Med. 2021 Jun 1; 44: 277-283.

ObjectiveMetabolic acidosis is commonly associated with the disease severity in patients with sepsis or septic shock. This study was performed to investigate the association between serum total carbon dioxide (TCO2) concentration and 28-day mortality in patients with sepsis.MethodsThis study was a multicenter retrospective cohort study of patients with sepsis or septic shock. The relationships between serum TCO2 and 28-day mortality, bicarbonate, pH, lactate, and anion gap were determined with cubic spline curves. The patients were divided into four groups according to their serum TCO2 concentration: Group I (TCO2 > 20 mmol/l), Group II (15 < TCO2 ≤ 20 mg/dl), Group III (10 < TCO2 ≤ 15 mmol/l), and Group IV (TCO2 ≤ 10 mmol/l).ResultsA total of 3168 patients were included in the analysis, and the overall mortality rate was 24.1%. Serum TCO2 concentrations below 20 mmol/l showed an almost linear correlation with mortality as well as with lactate, bicarbonate, and pH. The 28-day mortality rates of Group I, II, III, and IV were 18.3%, 23.6%, 32.6%, and 50.0%, respectively (p < .001). In Multivariable Cox proportional hazard regression analysis, the groups with lower serum TCO2 concentrations had a higher risk of 28-day mortality compared with Group I: Group II (Hazard ratio (HR), 1.35; 95% confidence interval (CI), 1.11-1.64), Group III (HR, 1.74; 95% CI, 1.37-2.21), and Group IV (HR, 2.72; 95% CI, 2.03-3.64).ConclusionsSerum TCO2 concentrations of 20 mmol/l or less were associated with 28-day mortality in patients with sepsis.Copyright © 2020 Elsevier Inc. All rights reserved.

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