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Is Serum Bicarbonate Level Associated With Negative Outcomes in Pediatric Patients?: A Retrospective Cohort Study
Naveen Poonai1, David Mainprize, Carolyn Travers
1From the *Division of Emergency Medicine, †Department of Paediatrics, Schulich School of Medicine and Dentistry, Western University; ‡Children's Health Research Institute, London Health Sciences Centre; §Department of Anesthesia, Schulich School of Medicine and Dentistry, Western University; and ∥Division of Food and Nutritional Sciences, Brescia University College at Western University, London, Ontario, Canada.
Insights
Serum bicarbonate levels can help identify children at risk for adverse outcomes in the emergency department. A level below 13 mEq/L significantly increases the risk of serious events, including death.
Area of Science:
- Pediatric Emergency Medicine
- Clinical Chemistry
- Biomarkers for Critical Illness
Background:
- Early identification of children at risk for adverse outcomes is crucial for timely intervention.
- Serum bicarbonate is a readily available and easily measured laboratory test.
- Understanding the predictive value of serum bicarbonate in pediatric emergency department (ED) populations is important.
Purpose of the Study:
- To describe the relationship between serum bicarbonate levels and adverse outcomes in children presenting to the ED.
- To evaluate the predictive ability of serum bicarbonate for specific adverse events.
- To assess the association between low serum bicarbonate and composite adverse outcomes.
Main Methods:
- Retrospective cohort study of children aged 0-17 years with measured serum bicarbonate in the ED.
- Analysis of data from January 1, 2007, to December 31, 2011.
- Primary outcome: predictive ability of bicarbonate for intensive care unit admission, assisted ventilation, inotropic support, cardiopulmonary resuscitation, or death.
- Secondary outcome: association between bicarbonate levels (<13 mEq/L vs. >13 mEq/L) and composite adverse outcomes.
Main Results:
- A serum bicarbonate level <18.5 mEq/L predicted inotropic support (AUC 0.69) and death (AUC 0.75).
- Children with bicarbonate <13 mEq/L had significantly higher rates of adverse outcomes (4.4% vs. 2.5%, P=0.001).
- The odds ratio for adverse outcomes with bicarbonate <13 mEq/L was 1.96 (95% CI, 1.3-2.97).
Conclusions:
- Serum bicarbonate levels, particularly <18.5 mEq/L, show fair specificity in predicting critical outcomes like inotropic support and death in pediatric ED patients.
- A serum bicarbonate level <13 mEq/L is significantly associated with increased risk of negative clinical outcomes.
- Routine measurement of serum bicarbonate is recommended for children at risk of clinical deterioration.
Objectives:
Early identification of children at risk for adverse outcomes is important. Serum bicarbonate is easily collected and widely available. We described the relationship between bicarbonate and adverse outcomes in children presenting to the emergency department (ED).
Methods:
We conducted a retrospective cohort study of children aged 0 to 17 years from January 1, 2007, to December 31, 2011, who had a serum bicarbonate measured in the ED. Primary outcome was the predictive ability of bicarbonate for the individual components of the composite outcome that included at least one of the following: intensive care unit admission, assisted ventilation, inotropic support, cardiopulmonary resuscitation, or death. Secondary outcome was the relationship between bicarbonate level of greater and less than 13 mEq/L and the composite outcome.
Results:
We reviewed 16,989 charts, of which 432 had an adverse outcome. Receiver operating characteristic curve analysis showed that a bicarbonate level of less than 18.5 mEq/L predicted inotropic support with an area under the curve of 0.69 (95% confidence interval [CI], 0.60-0.77; P < 0.001) and death with an area under the curve of 0.75 (CI, 0.66-0.85; P < 0.001). Significantly more patients with bicarbonate level of less than 13 mEq/L had at least 1 adverse outcome compared with those with bicarbonate level of greater than 13 mEq/L (4.4% vs 2.5%, P = 0.001), odds ratio 1.96 (95% CI, 1.3-2.97).
Conclusions:
Among children presenting to the ED, bicarbonate level of 18.5 mEq/L had fair specificity in predicting inotropic support and death. Negative outcomes are significantly associated with bicarbonate level of less than 13 mEq/L. Bicarbonate should routinely be measured in children at risk of clinical deterioration.
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