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Master Thesis

Long-term outcome of bicarbonate therapy for severe metabolic acidemia in intensive care unit patients, a BICAR-ICU post hoc analysis

Abstract : Severe acidaemia is a pathophysiological process frequently observed in critically ill patients and is associated with high in-hospital mortality. However, the long-term prognosis of critically ill patients with severe acidaemia at admission remains unknown. The objective of this study was to assess the quality of life and the long-term prognosis of critically ill patients with severe acidaemia, whether or not they received sodium bicarbonate infusion. Patients and methods: we did a post hoc analyses evaluating the quality of life and the prognosis at 5 yearsof surviving patients from the BICAR-ICU trial which included critically ill patients with severe acidaemia at admission.The primary outcome was health related quality of life measured by two validated and standardized questionnaires: SF-36 and EQ-5D. Secondary outcomes were mortality, presence of end-stage chronic renal disease requiring renal replacement therapy or kidney transplantation, place of residence, professional status and the need for a new hospitalization in intensive care units. Results: among the 389 patients enrolled in BICAR-ICU trial,198 (50.9%) were alive at 28-day. At 5-year, 42 (21.2%) patients were lost to follow-up and 82 patients had died. Of the 74 remaining patients, the quality of life was measured in 62 patients including 32 from the bicarbonate group and 30 from the control group. The quality of life of the surviving patients was reduced in the physical domains, particularly in the domain of physical role limitations (64 ± 41 in the control group and 49 ± 43 in the bicarbonate group; p = 0.28) but preserved in the emotional domains (respectively 96 ± 19 and 86 ± 34 in the control and bicarbonate groups; p 39=0.44). Using EQ-5D, 49 (79%) patients reported no difficulty to self-care and 31 (50%) patients no difficulty to mobility. The overall mortality at 5 years was 70% with no significantly difference between the 2 groups (70% in the bicarbonate group and 71% in the control group, p = 0.59). Respectively, 4 patients (11%) and 1 patient (3%) in the control and bicarbonate group required renal replacement therapy or kidney transplantation at 5 years without significantly difference (p 0.36). Conclusions: in critically ill patients with severe metabolic acidaemia at admission, the health related quality of life at 5 years in the physical domains was moderately reduced compared to that of the general population while the quality of life in the emotional domain was preserved. The 5-year prognosis was poor with high mortality. These results underline the importance of severe acidaemia as a criterion of short and long-term severity without having a major impact on the long-term quality of life of surviving patients.
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Master Thesis
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https://dumas.ccsd.cnrs.fr/dumas-03564703
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Submitted on : Wednesday, February 23, 2022 - 4:14:32 PM
Last modification on : Saturday, March 12, 2022 - 3:12:19 AM

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Eddine Bendiab. Long-term outcome of bicarbonate therapy for severe metabolic acidemia in intensive care unit patients, a BICAR-ICU post hoc analysis. Human health and pathology. 2021. ⟨dumas-03564703⟩

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