Outcome of Patients with Life Threatening Acidosis in Lower Middle Income Country ICU

INTRODUCTION: Severe acidosis with pH < 7 is a potentially life-threatening condition associated with very high mortality.(1) Very few retrospective studies have examined the prognostic variables of outcome in these patients. In this prospective observational study conducted in a Lower-Middle income country ICU with resource limitations, we studied the various patient variables associated with clinical outcome. METHODS: Consecutive ICU patients with severe acidosis(pH< 7) were included in this study. Patients with diabetic ketoacidosis were excluded. All the demographic, clinical, laboratory and treatment related parameters were analysed. Primary endpoint was in-hospital mortality, and secondary endpoints were 28-day mortality, variables associated with 28-day survival. Unpaired t-test and chi-square test were used for data analysis. Logistic regression and Cox proportional hazards model were used to identify mortality predictors and variables predicting survival, respectively. RESULTS: Among the 124 patients included in the study, 62.1% were male patients with average age of the study population being 60.55 years in survivors and 60.34 years in non survivors. The overall and 28-day mortality rates were 76.6%, with septic shock being the most common cause of severe acidosis and death. High APACHEII and high SOFA scores along with low albumin levels (p<0.001), high creatinine(p=0.008) and high bilirubin (p=0.035) strongly correlated with poor outcomes. Among the patients who survived type 1 and type 2 respiratory failure were common diagnoses. CONCLUSION: In a lower- middle income country with resource limited ICU in patients who had severe acidosis, high bilirubin, high creatinine and low albumin along with high APACHE II and high SOFA score were associated with higher mortality whereas patients having type 1 and type 2 respiratory failure had higher survival.