Lactate Concentration, Base Excess and Alactic Base Excess (ABE) as predictors of ICU outcome in patients with sepsis and septic shock :An observational study

Project details- Shock is a life threatening hemodynamic emergency leading to hypo perfusion of tissue and cause severe metabolic changes at cellular level. Acid base imbalance in shock is due to low oxygen delivery to tissue, high oxygen consumption or inadequate utilization which leads to various metabolic derangements with or without hyperlactataemia. Hyperlactetemia may be accompanied by metabolic acidosis or as a separate entity not affecting the acid-base status. In 2019, Gattinoni et al introduced a new term alactic base excess (ABE) to differentiate between metabolic acidosis caused by lactate accumulation and non lactate fixed acids (unmeasured fixed ions) not eliminated by lungs, eg sulphates and phosphates. Conceptually ABE is the sum of negative values of base excess and lactate. The effect of ABE in septic patients was studied by Gattinoni at el and they concluded that it possibly reflects the impact of renal dysfunction on plasma lactate concentration and acid base balance. They also found that increased plasma lactate indicates sepsis severity and that ABE can be used to estimate renal capacity to handle acid base balance. “Alactic base excess” (ABE) recently introduced by Gattinoni et al is the sum of base excess and lactate (ABE= BE+L). ABE represents the number/concentration of abnormal strong acids other than lactate in plasma. Nevertheless, the predictive value of ABE has not yet been investigated in different septic shock patients and needs validation in ICU settings.so in this observational study we aim to investigate the further potential prognostic value of ABE and its contributors, i.e., lactate concentration and BE to predicting 28 days mortality in shock patients admitted in our ICU. Simultaneously we will examine duration and dose of vasopressors use in sepsis and septic shock patients,days of vasopressor use,stage and progression of AKI at admission and during ICU stay,need of RRT during ICU stay,total days of Mechanical ventilation,total length of ICU stay / total days of hospitalization as seconary objectives.