Associations of the Serum Total Carbon Dioxide Level with Long-Term Clinical Outcomes in Sepsis Survivors

INTRODUCTION: Sepsis is characterized by a dysregulated host response to infection that leads to multiple organ dysfunction and often complicated with metabolic acidosis. However, the associations between serum total carbon dioxide level (TCO(2)) and long-term clinical outcomes in sepsis survivors remains unknown. METHODS: A total of 7212 sepsis survivors aged ≥ 20 years who were discharged from January 1, 2008 to December 31, 2018 were included in our analyses. The sepsis survivors were further divided into high TCO(2) (≥ 18 mmol/L) and low TCO(2) (< 18 mmol/L) groups, comprising 5023 and 2189 patients, respectively. The following outcomes of interest were included: all-cause mortality, myocardial infarction, ischemic stroke, hospitalization for heart failure, ventricular arrhythmia, and end-stage renal disease (ESRD). RESULTS: After propensity score matching, the low TCO(2) group was at higher risks of all-cause mortality (hazard ratio [HR] 1.28, 95% confidence interval [95% CI] 1.18–1.39), myocardial infarction (HR 1.83, 95% CI 1.39–2.43), and ESRD (HR 1.38, 95% CI 1.16–1.64) than the high TCO(2) group. The results remained similar after considering death as a competing risk. CONCLUSION: Patients discharged from hospitalization for sepsis have higher risks of worse long-term clinical outcomes. Physicians may need to pay more attention to sepsis survivors whose TCO(2) was low. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s40121-023-00765-6.