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Peer-reviewedCC BY-NC 4.0Science Progress

Early 8.4% sodium bicarbonate and in-hospital mortality in cardiogenic shock with severe acidemia and hyperlactatemia: A two-hour landmark overlap-weighted retrospective cohort study

  • Xingwei Wang1
  • Yang Gao2
  • Qingbo Shi2
  • Cao Ma3
  • Yahui Liu2
  1. 1Department of Comprehensive Intensive Care, Fuwai Central China Cardiovascular Hospital, Henan Cardiovascular Disease Center (Central China Subcenter of National Center for Cardiovascular Diseases), Central China Fuwai Hospital of Zhengzhou University, Henan Provincial Cardiovascular Hospital, Zhengzhou, China
  2. 2Henan Key Laboratory of Coronary Heart Disease Control & Prevention, Fuwai Central China Cardiovascular Hospital, Henan Cardiovascular Disease Center (Central China Subcenter of National Center for Cardiovascular Diseases), Central China Fuwai Hospital of Zhengzhou University, Henan Provincial Cardiovascular Hospital, Zhengzhou, China
  3. 3Department of Emergency, Fuwai Central China Cardiovascular Hospital, Henan Cardiovascular Disease Center (Central China Subcenter of National Center for Cardiovascular Diseases), Central China Fuwai Hospital of Zhengzhou University, Henan Provincial Cardiovascular Hospital, Zhengzhou, China
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Abstract

Objective: To evaluate the association between early concentrated 8.4% sodium bicarbonate and subsequent in-hospital mortality in patients with cardiogenic shock, severe acidemia, and hyperlactatemia.

Methods: We conducted a retrospective two-hour landmark cohort study using the single-center MIMIC-IV v3.1 database. True time zero was the first time pH ≤7.20 and lactate ≥4 mmol/L were both known within a two-hour pairing window. Patients with pre-time-zero bicarbonate exposure, renal replacement therapy, or diabetic ketoacidosis were excluded. Patients alive and still hospitalized at two hours were classified according to 8.4% sodium bicarbonate administration during the 0- to 2-hour window. Propensity-score overlap weighting was used to balance baseline covariates. The primary outcome was subsequent in-hospital mortality.

Results: Among 489 landmark patients, 110 received early 8.4% bicarbonate and 379 did not. After overlap weighting, the maximum absolute standardized mean difference was 0.091. Weighted mortality was 80.4% with early bicarbonate versus 70.2% without early treatment, corresponding to a risk difference of 10.2 percentage points (95% CI, −0.1 to 20.4; P=.052) and a risk ratio of 1.145 (95% CI, 1.001–1.310; P=.049). Sensitivity analyses showed broadly consistent point estimates, although confidence intervals and target overlap populations varied.

Conclusions: Early 8.4% sodium bicarbonate did not demonstrate a survival benefit among patients who survived to the two-hour landmark. Estimates were directionally compatible with higher mortality, but residual confounding and statistical uncertainty preclude a causal conclusion of harm.

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Cite

BibTeXRIS
BibTeX
@article{wang2026early,
  title = {{Early 8.4% sodium bicarbonate and in-hospital mortality in cardiogenic shock with severe acidemia and hyperlactatemia: A two-hour landmark overlap-weighted retrospective cohort study}},
  author = {Xingwei Wang and Yang Gao and Qingbo Shi and Cao Ma and Yahui Liu},
  journal = {Science Progress},
  year = {2026},
  month = sep,
  doi = {10.1177/00368504261492494},
  url = {https://doi.org/10.1177/00368504261492494},
  note = {CC BY-NC 4.0},
}
RIS
TY  - JOUR
TI  - Early 8.4% sodium bicarbonate and in-hospital mortality in cardiogenic shock with severe acidemia and hyperlactatemia: A two-hour landmark overlap-weighted retrospective cohort study
AU  - Xingwei Wang
AU  - Yang Gao
AU  - Qingbo Shi
AU  - Cao Ma
AU  - Yahui Liu
PY  - 2026
DA  - 2026/09/29
JO  - Science Progress
DO  - 10.1177/00368504261492494
UR  - https://doi.org/10.1177/00368504261492494
AB  - Objective: To evaluate the association between early concentrated 8.4% sodium bicarbonate and subsequent in-hospital mortality in patients with cardiogenic shock, severe acidemia, and hyperlactatemia.  Methods: We conducted a retrospective two-hour landmark cohort study using the single-center MIMIC-IV v3.1 database. True time zero was the first time pH ≤7.20 and lactate ≥4 mmol/L were both known within a two-hour pairing window. Patients with pre-time-zero bicarbonate exposure, renal replacement therapy, or diabetic ketoacidosis were excluded. Patients alive and still hospitalized at two hours were classified according to 8.4% sodium bicarbonate administration during the 0- to 2-hour window. Propensity-score overlap weighting was used to balance baseline covariates. The primary outcome was subsequent in-hospital mortality.  Results: Among 489 landmark patients, 110 received early 8.4% bicarbonate and 379 did not. After overlap weighting, the maximum absolute standardized mean difference was 0.091. Weighted mortality was 80.4% with early bicarbonate versus 70.2% without early treatment, corresponding to a risk difference of 10.2 percentage points (95% CI, −0.1 to 20.4; P=.052) and a risk ratio of 1.145 (95% CI, 1.001–1.310; P=.049). Sensitivity analyses showed broadly consistent point estimates, although confidence intervals and target overlap populations varied.  Conclusions: Early 8.4% sodium bicarbonate did not demonstrate a survival benefit among patients who survived to the two-hour landmark. Estimates were directionally compatible with higher mortality, but residual confounding and statistical uncertainty preclude a causal conclusion of harm.
SN  - 0036-8504
SN  - 2047-7163
ER  -