Evaluation of Mortality and Prognostic Factors in Patients Presenting to the Emergency Department with Extreme Acidemia: A Retrospective Cohort Study
- 1Department of Emergency Medicine, Prof. Dr. Cemil Tascioglu City Hospital, Istanbul 34384, Turkey
- 2Department of Medical Biochemistry, Prof. Dr. Cemil Tascioglu City Hospital, Istanbul 34384, Turkey
- 3Department of Internal Medicine, Marmara University Pendik Training and Research Hospital, Istanbul 34899, Turkey
Abstract
Objectives: Extreme acidemia is associated with high mortality, but prognosis may depend more on the clinical context than on pH alone. This study evaluated 24-h and 30-day mortality and associated prognostic factors in adults presenting to the emergency department (ED) with extreme acidemia. Materials and Methods: This single-center retrospective cohort study included adults with an initial ED blood gas pH < 6.90. Demographic, clinical, etiological, and laboratory variables were recorded. Separate multivariable logistic regression models were constructed for 24-h and 30-day all-cause mortality. Results: A total of 413 patients were included. Median age was 60 years, 60.8% were male, and 50.4% presented with ongoing CPR. Mortality was 49.2% at 24 h and 75.5% at 30 days. Older age was independently associated with 24-h (aOR 1.35 per 10-year increase; 95% CI 1.14–1.60) and 30-day mortality (aOR 1.47; 95% CI 1.21–1.79). Ongoing CPR at ED arrival showed the strongest association with mortality at 24 h (aOR 16.25; 95% CI 8.71–30.30) and 30 days (aOR 15.22; 95% CI 5.94–38.98). Higher potassium was also independently associated with both outcomes. Admission pH was not independently associated with mortality after adjustment. Model AUCs were 0.896 and 0.904 for 24-h and 30-day mortality, respectively. Conclusions: Mortality is high among patients presenting with extreme acidemia. Within this cohort restricted to pH < 6.90, admission pH was not independently associated with mortality after adjustment, whereas older age, ongoing CPR at ED arrival, and elevated serum potassium were independently associated with both outcomes. The absence of an independent association between admission pH and mortality should be interpreted cautiously, because the restricted pH range and residual confounding may have attenuated its observed prognostic contribution within this cohort.
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BibTeX
@article{ferhatlar2026evaluation,
title = {{Evaluation of Mortality and Prognostic Factors in Patients Presenting to the Emergency Department with Extreme Acidemia: A Retrospective Cohort Study}},
author = {Mehmet Esat Ferhatlar and Yavuzselim Koca and Mehmet Akif Ülgen and Abdurrahman Ak and Beyazit Semih Yesil and Berkan Darbaz and Mehmet Alptekin Acar and Oner Bozan and Asim Kalkan},
journal = {Journal of Clinical Medicine},
year = {2026},
month = nov,
doi = {10.3390/jcm15228795},
url = {https://www.mdpi.com/2077-0383/15/22/8795},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Evaluation of Mortality and Prognostic Factors in Patients Presenting to the Emergency Department with Extreme Acidemia: A Retrospective Cohort Study
AU - Mehmet Esat Ferhatlar
AU - Yavuzselim Koca
AU - Mehmet Akif Ülgen
AU - Abdurrahman Ak
AU - Beyazit Semih Yesil
AU - Berkan Darbaz
AU - Mehmet Alptekin Acar
AU - Oner Bozan
AU - Asim Kalkan
PY - 2026
DA - 2026/11/10
JO - Journal of Clinical Medicine
DO - 10.3390/jcm15228795
UR - https://www.mdpi.com/2077-0383/15/22/8795
AB - Objectives: Extreme acidemia is associated with high mortality, but prognosis may depend more on the clinical context than on pH alone. This study evaluated 24-h and 30-day mortality and associated prognostic factors in adults presenting to the emergency department (ED) with extreme acidemia. Materials and Methods: This single-center retrospective cohort study included adults with an initial ED blood gas pH < 6.90. Demographic, clinical, etiological, and laboratory variables were recorded. Separate multivariable logistic regression models were constructed for 24-h and 30-day all-cause mortality. Results: A total of 413 patients were included. Median age was 60 years, 60.8% were male, and 50.4% presented with ongoing CPR. Mortality was 49.2% at 24 h and 75.5% at 30 days. Older age was independently associated with 24-h (aOR 1.35 per 10-year increase; 95% CI 1.14–1.60) and 30-day mortality (aOR 1.47; 95% CI 1.21–1.79). Ongoing CPR at ED arrival showed the strongest association with mortality at 24 h (aOR 16.25; 95% CI 8.71–30.30) and 30 days (aOR 15.22; 95% CI 5.94–38.98). Higher potassium was also independently associated with both outcomes. Admission pH was not independently associated with mortality after adjustment. Model AUCs were 0.896 and 0.904 for 24-h and 30-day mortality, respectively. Conclusions: Mortality is high among patients presenting with extreme acidemia. Within this cohort restricted to pH < 6.90, admission pH was not independently associated with mortality after adjustment, whereas older age, ongoing CPR at ED arrival, and elevated serum potassium were independently associated with both outcomes. The absence of an independent association between admission pH and mortality should be interpreted cautiously, because the restricted pH range and residual confounding may have attenuated its observed prognostic contribution within this cohort.
SN - 2077-0383
ER -