Prognostic Value of Alactic Base Excess for 28 Day Mortality in Sepsis Patients: A Retrospective Prognostic Accuracy Study in an Intensive Care Unit

Paulus Sulistiono, Reza Widianto Sudjud, Dhany Budipratama

Abstract


Introduction: Prognostication in sepsis is challenging. Serum lactate is widely used but cannot separate non-lactate contributions to metabolic acidosis. Alactic Base Excess (ABE) provides a more complete assessment of acid–base status. This study assessed ABE’s value in predicting 28-day mortality in sepsis patients.

Methods: A retrospective study included 109 adult sepsis patients meeting Sepsis-3 criteria with arterial blood gas analysis within 24 hours of ICU admission. ABE was calculated from base excess and lactate. Prognostic performance was evaluated using ROC analysis, and association with mortality was assessed using odds ratios (OR).

Results: Of 109 patients, 59 (54.1%) died within 28 days. Non-survivors had more negative median ABE than survivors (-7.04 vs. -0.15; p<0.001). Optimal ABE cut-off was ≤ -4.1. Patients with ABE ≤-4.1 had a higher risk of mortality (OR 38.6; 95% CI: 13.2–112.9; p<0.001).

Discussion: ABE showed strong prognostic performance, reflecting non-lactate metabolic acidosis not captured by lactate alone. As it is derived from routine arterial blood gas analysis, ABE is practical for early risk stratification in critically ill sepsis patients.

Conclusion: ABE demonstrates excellent prognostic value for 28-day mortality in ICU sepsis patients. An ABE ≤-4.1 is linked to significantly higher mortality and may serve as a readily available biomarker for early risk assessment and timely clinical decisions.


Keywords


Alactic base excess; Intensive Care Unit; mortality; prognosis; sepsis

Full Text:

PDF

References


  1. Rudd KE, Johnson SC, Agesa KM, Shackelford KA, Tsoi D, Kievlan DR, et al. Global, regional, and national sepsis incidence and mortality, 1990-2017: analysis for the Global Burden of Disease Study. Lancet. 2020;395(10219):200–11. doi:10.1016/S0140-6736(19)32989-7.
  2. Phua J, Koh Y, Du B, Tang YQ, Divatia JV, Tan CC, et al. Management of severe sepsis in patients admitted to asian intensive care units: prospective cohort study. BMJ. 2011;342:d3245. doi:10.1136/bmj.d3245.
  3. Fleischmann C, Scherag A, Adhikari NK, Hartog CS, Tsaganos T, Schlattmann P, et al. Assessment of global incidence and mortality of hospital-treated sepsis current estimates and limitations, 1979-2015. Am J Respir Crit Care Med. 2016;193(3):259–72. doi:10.1164/rccm.201504-0781OC.
  4. Doganyigit Z, Eroglu E, Akyuz E Inflammatory mediators of cytokines and chemokines in sepsis: From bench to bedside. Hum Exp Toxicol 2022;41:9603271221078871 doi:101177/09603271221078871.
  5. Liu J, Chen Y, Yang B, Zhao J, Tong Q, Yuan Y, et al. Association between alactic base excess on mortality in sepsis patients: a retrospective observational study. J Intensive Care. 2025;13(1):20 doi:101186/s40560-025-00789-9.
  6. Mandal L, Rijal G, Singh R, Tiwari B, Jahan F, Lama D, et al. Sepsis among patients admitted to the intensive care unit of a tertiary care centre. JNMA J Nepal Med Assoc. 2023;61(265):691−4. doi:1031729/jnma8275.
  7. Singer M, Deutschman CS, Seymour CW, Shankar-Hari M, Annane D, Bauer M, et al. The third international consensus definitions for sepsis and septic shock (sepsis-3). JAMA 2016;315:801-10. doi: 10.1001/jama.2016.0287
  8. Thompson K, Hammond N, Bailey M, Darvall J, Low G, McGloughlin S, et al. Sex differences in long-term survival after intensive care unit treatment for sepsis: cohort study. PLoS One.2023;18(2):e0281939. doi:101371/journal.pone0281939.
  9. Sunden-Cullberg J, Nilsson A, Inghammar M. Sex-based differences in ED management of critically ill patients with sepsis, 2008-2015: a nationwide cohort study Intensive Care Med 2020;46(4):727–36 doi:101007/s00134-019-05910-9.
  10. Chang Z, Lu J, Zhang Q, Wu H, Liang Z, Pan X, et al. Clinical biomarker profiles reveals gender differences and mortality factors in sepsis. Front Immunol. 2024;15:1413729. doi:103389/fimmu20241413729.
  11. Sharma AK, Azim A, Gurjar M, Poddar B Lactate concentration, base excess (SBE), and alactic base excess (ABE) as predictors of ICU outcome in patients with sepsis and septic shock: an observational study. Indian J Crit Care Med.2025;29(1):S162 doi:10.5005/jaypee-journals-10071-24933.119.
  12. Smuszkiewicz P, Jawień N, Szrama J, Lubarska M, Kusza K, Guzik P. Admission lactate concentration, base excess, and alactic base excess predict the 28-day inward mortality in shock patients. J Clin Med. 2022;11(20):6125. doi:10.3390/jcm11206125.
  13. Musso CG, Cordoba JP, Aroca-Marinez G, Terrasa S, Moreno APB, Sanchez ML, et al. Negative alactic base excess is reversed by hemoperfusion in septic patients. Glob Clin Nephrol Dial. 2022;1(2):122. doi:1033393/gcnd20222490.
  14. Seo MH, Choa M, You JS, Lee HS, Hong JH, Park YS, et al. Hypoalbuminemia, low base excess values, and tachypnea predict 28-day mortality in severe sepsis and septic shock patients in the emergency department. Yonsei Med J. 2016;57(6):1361−9 doi:103349/ymj20165761361.
  15. Yuan J, Liu X, Liu Y, Li W, Chen X, Chen Q, et al. Association between base excess and 28-day mortality in sepsis patients: A secondary analysis based on the MIMIC- IV database Heliyon 2023;9(5):e15990.doi:101016/j.heliyon2023.e15990.
  16. Zhu B, Zhou R, Qin J, Li Y. Hierarchical capability in distinguishing severities of sepsis via serum lactate: a network meta-analysis. Biomedicines. 2024;12(2):447. doi:10.3390/biomedicines12020447.




DOI: https://doi.org/10.15851/jap.v13n3.4591

Article Metrics

Abstract view : 7 times
PDF - 2 times


 

This Journal indexed by

                   

           


 
Creative Commons License
JAP is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License

 



View My Stats