Prognostic Impact of Alactic Base Excess in Critically Ill Patients with Sepsis-Associated Disseminated Intravascular Coagulation: A Retrospective Observational Study

ObjectiveTo evaluate the association between alactic base excess (ABE) and mortality outcomes in patients with sepsis-associated disseminated intravascular coagulation (DIC) within intensive care unit (ICU).MethodsPatients with sepsis-associated DIC were identified using Sepsis-3 criteria and the Japanese Association for Acute Medicine 2 DIC criteria. Multivariable Cox models and restricted cubic splines (RCS) were used to assess the relationship between ABE and 30-day and 90-day ICU mortality, with inflection points derived from a recursive algorithm. The predictive value of adding ABE to the Sequential Organ Failure Assessment (SOFA) score was further compared with SOFA alone.ResultsA total of 4839 patients with sepsis-associated DIC were included (median age 67.2 years; 59.8% male). Compared with Q3, multivariable Cox models showed higher 30-day mortality in Q1 (HR = 1.44, 95% CI 1.16-1.79), Q2 (HR = 1.26, 95% CI 1.01-1.57), and Q4 (HR = 1.45, 95% CI 1.15-1.81), with similar patterns for 90-day mortality (Q1: HR = 1.38, 95% CI 1.13-1.68; Q2: HR = 1.28, 95% CI 1.04-1.56; Q4: HR = 1.45, 95% CI 1.18-1.77). RCS analysis demonstrated a U-shaped association between ABE and mortality, with risk increasing at both low and high ABE levels. Adding ABE to SOFA significantly improved prediction for 30-day and 90-day mortality, with notable reclassification gains.ConclusionA clear U-shaped association was observed between ABE and 30-day/90-day ICU mortality in the patients with sepsis-associated DIC, suggesting that deviations from mid-range values may reflect early metabolic deterioration. However, the clinical implications require cautious interpretation and further validation in larger or prospective cohorts.