Intensive Care Medicine

, Volume 44, Issue 11, pp 1888–1895 | Cite as

Effectiveness of sodium bicarbonate infusion on mortality in septic patients with metabolic acidosis

  • Zhongheng ZhangEmail author
  • Carlie Zhu
  • Lei Mo
  • Yucai Hong



Although sodium bicarbonate (SB) solution has been widely used in clinical practice, its effect on mortality when administered to a large population of patients with acidosis is not known. The study aimed to investigate the effectiveness of SB infusion in septic patients with metabolic acidosis.


Septic patients with metabolic acidosis were identified from the Medical Information Mart for Intensive Care (MIMIC)-III database. Propensity score (PS) was used to account for the baseline differences in the probability to receive SB or not. The marginal structural Cox model (MSCM) was employed to adjust for both baseline and time-varying confounding factors.

Main results

A total of 1718 septic patients with metabolic acidosis were enrolled in the study, including 500 in the SB group and 1218 in the non-SB group. Both pH [7.16 (standard deviation (SD): 0.10) vs. 7.22 (SD: 0.07); p < 0.001] and bicarbonate concentration (BC) [11.84 (SD: 3.63) vs. 14.88 (SD: 3.36) mmol/l; p < 0.001] were significantly lower in the SB than that in the non-SB group. While there was no significant mortality effect in the overall population [hazard ratio (HR): 1.04; 95% CI 0.86–1.26; p = 0.67], SB was observed to be beneficial in patients with acute kidney injury (AKI) stage 2 or 3 and pH < 7.2 (HR 0.74; 95% CI 0.51–0.86; p = 0.021). Similar results were replicated with the MSCM.


Our study observed that SB infusion was not associated with improved outcome in septic patients with metabolic acidosis, but it was associated with improved survival in septic patients with AKI stage 2 or 3 and severe acidosis. The results need to be verified in randomized controlled trials.


Sodium bicarbonate Critical care Sepsis Mortality Marginal structural Cox Model 



Z.Z. received funding from The public welfare research project of Zhejiang province (LGF18H150005) and Scientific research project of Zhejiang Education Commission (Y201737841).

Compliance with ethical standards

Conflicts of interest

There is no conflict of interest.

Supplementary material

134_2018_5379_MOESM1_ESM.docx (296 kb)
Supplementary material 1 (DOCX 295 kb)


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature and ESICM 2018

Authors and Affiliations

  1. 1.Department of Emergency Medicine, Sir Run Run Shaw HospitalZhejiang University School of MedicineHangzhouChina
  2. 2.Department of Clinical Statistics3M China Research and Development CenterShanghaiChina
  3. 3.Department of BiostatisticsLejiu Healthcare Technology Co., LtdShanghaiChina

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