Base excess is associated with the risk of all-cause mortality in critically ill patients with acute myocardial infarction

Abstract

Background: Base excess (BE) represents an increase or decrease of alkali reserves in plasma to diagnose acid-base disorders, independent of respiratory factors. Current findings about the prognostic value of BE on mortality of patients with acute myocardial infarction (AMI) are still unclear. The purpose of this study was to explore the prognostic significance of BE for short-term all-cause mortality in patients with AMI. Methods: A total of 2,465 patients diagnosed with AMI in the intensive care unit from the Medical Information Mart for Intensive Care III (MIMIC-III) database were included in our study, and we explored the association of BE with 28-day and 90-day all-cause mortality using Cox regression analysis. We also used restricted cubic splines (RCS) to evaluate the relationship between BE and hazard ratio (HR). The primary outcomes were 28-day and 90-day all-cause mortality. Results: When stratified according to quantiles, low BE levels at admission were strongly associated with higher 28-day and 90-day all-cause mortality. Multivariable Cox proportional hazard models revealed that low BE was an independent risk factor of 28-day all-cause mortality [HR 4.158, 95% CI 3.203–5.398 (low vs. normal BE) and HR 1.354, 95% CI 0.896–2.049 (high vs. normal BE)] and 90-day all-cause mortality [HR 4.078, 95% CI 3.160–5.263 (low vs. normal BE) and HR 1.369, 95% CI 0.917–2.045 (high vs. normal BE)], even after adjustment for significant prognostic covariates. The results were also consistent in subgroup analysis. RCS revealed an “L-type” relationship between BE and 28-day and 90-day all-cause mortality, as well as adjusting for confounding variables. Meanwhile, Kaplan–Meier survival curves were stratified by combining BE with carbon dioxide partial pressure (PaCO2), and patients had the highest mortality in the group which had low BE (< 3.5 mEq/L) and high PaCO2 (> 45 mmHg) compared with other groups. Conclusion: Our study revealed that low BE was significantly associated with 28-day and 90-day mortality in patients with AMI and indicated the value of stratifying the mortality risk of patients with AMI by BE.