Thesis (Ph.D.) - Cairo University - Faculty of Medicine - Department of Critical Care Medicine

Background: Acid base disturbances, especially metabolic acidosis are common in septic patients. Physicochemical approach described by Stewart and modified by Figge quantify precisely metabolic acidosis and gives insight into its main mechanisms, as well as influence of unmeasured anion on metabolic acidosis. Aim. The aims of this study were to determine the role of acid base variables obtained on admission to ICU and 24 hours later predicting outcome in septic patients; whether the strong ion differences (SID) and strong ions gap (SIG) correlate with outcome from sepsis; comparison of predictive value of acid base variables or SID/SIG variables versus other well-known severity scores (like APATCHE II and SOFA scores). Results. Acute physiology and chronic health evaluation (APACHE II), SOFA score, SIG, SIDe, anion gap (AG), corrected anion gap and SBE were statistically significant predictors. Serum lactic acid had non-significant discriminating ability between survivors and non survivors, but lactate clearance had better ability. ROC analysis results showed that SIG followed by SIDe had the largest area below the curve and were more sensitive and specific than other predictors.

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