NHIỄM TOAN NẶNG VÀ MỐI LIÊN QUAN VỚI TỬ VONG Ở BỆNH NHÂN SỐC NHIỄM KHUẨN

Abstract

Background: Severe acidosis is both a consequence and an aggravating factor of hemodynamic disturbances. Objective: This study aimed to determine the prevalence and the association of severe acidosis with mortality, as well as the predictive value of the CAS score in septic shock. Methods: We enrolled all patients aged ≥18 years with septic shock according to Sepsis-3 criteria from November 2022 to June 2023. Severe acidosis was defined as a CAS score ≥2. The primary outcome was in-hospital mortality; secondary outcomes included 3-day early mortality and organ support-free days. ROC analysis was used to evaluate the predictive ability of the CAS score for mortality. Logistic regression and Cox regression analyses were performed to assess the association between severe acidosis and mortality. Results: A total of 93 patients were analyzed. The predictive ability of the CAS score was comparable to blood lactate, with poor prediction of in-hospital mortality but fair prediction of 3-day mortality. Patients with severe acidosis (48.4%) had higher mortality rates, and fewer organ support-free days compared to those without severe acidosis. Severe acidosis was associated with 3-day mortality (aHR = 3.21, 95%CI 1.27–8.14) after adjustment for lactate levels, SOFA scores, and vasopressor doses, but was not associated with in-hospital mortality. Conclusion: Severe acidosis is common in septic shock and is associated with 3-day mortality and increased need for organ support. The CAS score predicts 3-day mortality better than in-hospital mortality, with an accuracy comparable to that of blood lactate.