{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,16]],"date-time":"2026-09-16T17:09:10Z","timestamp":1789578550860,"version":"build-2803163510"},"reference-count":46,"publisher":"SAGE Publications","issue":"3","license":[{"start":{"date-parts":[[2025,7,1]],"date-time":"2025-07-01T00:00:00Z","timestamp":1751328000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"},{"start":{"date-parts":[[2025,7,1]],"date-time":"2025-07-01T00:00:00Z","timestamp":1751328000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"funder":[{"DOI":"10.13039\/501100001809","name":"National Natural Science Foundation of China","doi-asserted-by":"crossref","award":["82274320"],"award-info":[{"award-number":["82274320"]}],"id":[{"id":"10.13039\/501100001809","id-type":"DOI","asserted-by":"crossref"}]},{"DOI":"10.13039\/501100001809","name":"National Natural Science Foundation of China","doi-asserted-by":"crossref","award":["82374379"],"award-info":[{"award-number":["82374379"]}],"id":[{"id":"10.13039\/501100001809","id-type":"DOI","asserted-by":"crossref"}]},{"name":"Qilu Wellness and Health Leading Talent Training Project in 2020","award":["rc2021002-03"],"award-info":[{"award-number":["rc2021002-03"]}]},{"DOI":"10.13039\/501100007129","name":"Shandong Province Natural Science Foundation","doi-asserted-by":"crossref","award":["ZR2024MH076"],"award-info":[{"award-number":["ZR2024MH076"]}],"id":[{"id":"10.13039\/501100007129","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Dose-Response"],"published-print":{"date-parts":[[2025,7]]},"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>The elevated mortality rate associated with sepsis is a primary global health concern. The correlation between bicarbonate levels and mortality risk in sepsis remains unclear.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Method<\/jats:title>\n                    <jats:p>A retrospective cohort study was conducted using data from the MIMIC-IV database, including 12\u00a0744 adult sepsis patients. The primary exposure was serum bicarbonate levels, categorized into quintiles. The primary outcome was 28-day mortality, and secondary outcomes included 90-day mortality. Multivariable Cox regression models adjusted for demographic, clinical, and laboratory variables were used to examine the relationship between bicarbonate levels and mortality. Curve fitting and sensitivity analyses were performed to validate the findings.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>A U-shaped relationship between serum bicarbonate levels and 28-day mortality was identified. Both low (\u226419.0 mEq\/L) and high (&gt;26.0 mEq\/L) bicarbonate levels were associated with increased mortality risk. Patients with bicarbonate levels between 24.0-26.0 mEq\/L had the lowest 28-day mortality. The relationship remained consistent across subgroups, and an inflection point was observed at 25.0 mEq\/L. Sensitivity analyses confirmed the robustness of the findings across different data imputations.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>This study demonstrates that both low and high serum bicarbonate levels are associated with increased mortality in sepsis patients. The optimal bicarbonate range for minimizing mortality risk appears to be between 24.0-26.0 mEq\/L. These findings highlight the importance of monitoring bicarbonate levels in clinical practice, suggesting that maintaining bicarbonate within this range may improve patient outcomes. Further prospective studies are needed to confirm these findings and explore potential therapeutic strategies.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/15593258251374417","type":"journal-article","created":{"date-parts":[[2025,8,28]],"date-time":"2025-08-28T05:50:32Z","timestamp":1756360232000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":3,"title":["The U-Shaped Relationship Between Serum Bicarbonate Levels and 28-Day Mortality in Patients With Sepsis: A Retrospective Cohort Study of MIMIC-IV Database"],"prefix":"10.1177","volume":"23","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3343-2312","authenticated-orcid":false,"given":"Minghao","family":"Liang","sequence":"first","affiliation":[{"name":"First Clinical Medical College, Shandong University of Traditional Chinese Medicine, Jinan, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Feilong","family":"Guan","sequence":"additional","affiliation":[{"name":"First Clinical Medical College, Shandong University of Traditional Chinese Medicine, Jinan, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lili","family":"Sun","sequence":"additional","affiliation":[{"name":"First Clinical Medical College, Shandong University of Traditional Chinese Medicine, Jinan, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wenjing","family":"Xi","sequence":"additional","affiliation":[{"name":"First Clinical Medical College, Shandong University of Traditional Chinese Medicine, Jinan, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hongling","family":"Jia","sequence":"additional","affiliation":[{"name":"First Clinical Medical College, Shandong University of Traditional Chinese Medicine, Jinan, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yifei","family":"Xu","sequence":"additional","affiliation":[{"name":"First Clinical Medical College, Shandong University of Traditional Chinese Medicine, Jinan, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Minyan","family":"Jin","sequence":"additional","affiliation":[{"name":"Department of Pulmonary Disease, Guang\u2019anmen Hospital Jinan China Academy of Chinese Medical Sciences, Jinan, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xianhai","family":"Chen","sequence":"additional","affiliation":[{"name":"Department of Respiratory and Critical Care Medicine, The Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Di","family":"Huang","sequence":"additional","affiliation":[{"name":"Department of Respiratory and Critical Care Medicine, The Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zhanjun","family":"Qiu","sequence":"additional","affiliation":[{"name":"Department of Gerontology, The Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan, China"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2025,8,27]]},"reference":[{"key":"e_1_3_5_2_2","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2016.0287"},{"key":"e_1_3_5_3_2","doi-asserted-by":"publisher","DOI":"10.3389\/fcvm.2022.950029"},{"key":"e_1_3_5_4_2","doi-asserted-by":"publisher","DOI":"10.3389\/fphar.2023.1101240"},{"key":"e_1_3_5_5_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ebiom.2023.104938"},{"key":"e_1_3_5_6_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00134-020-06151-x"},{"key":"e_1_3_5_7_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(19)32989-7"},{"key":"e_1_3_5_8_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(18)30696-2"},{"key":"e_1_3_5_9_2","doi-asserted-by":"publisher","DOI":"10.1097\/CCM.0000000000005337"},{"key":"e_1_3_5_10_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.chest.2016.06.020"},{"key":"e_1_3_5_11_2","doi-asserted-by":"publisher","DOI":"10.1097\/CCM.0000000000003119"},{"key":"e_1_3_5_12_2","doi-asserted-by":"publisher","DOI":"10.1378\/chest.15-1703"},{"key":"e_1_3_5_13_2","doi-asserted-by":"publisher","DOI":"10.2174\/187153010791936900"},{"key":"e_1_3_5_14_2","doi-asserted-by":"publisher","DOI":"10.3389\/fimmu.2024.1483400"},{"key":"e_1_3_5_15_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.kint.2016.07.032"},{"key":"e_1_3_5_16_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00134-015-3649-9"},{"key":"e_1_3_5_17_2","doi-asserted-by":"publisher","DOI":"10.1097\/00003246-199201000-00020"},{"key":"e_1_3_5_18_2","first-page":"46","article-title":"Etiology and symptoms of severe hypokalemia in emergency department patients","volume":"21","author":"Marti G","year":"2014","unstructured":"Marti G, Schwarz C, Leichtle AB, et al. Etiology and symptoms of severe hypokalemia in emergency department patients. Eur J Emerg Med. 2014;21:46-51.","journal-title":"Eur J Emerg Med"},{"key":"e_1_3_5_19_2","doi-asserted-by":"publisher","DOI":"10.1681\/ASN.2014020205"},{"key":"e_1_3_5_20_2","doi-asserted-by":"publisher","DOI":"10.1093\/ndt\/gfs609"},{"key":"e_1_3_5_21_2","doi-asserted-by":"publisher","DOI":"10.2215\/CJN.03730411"},{"key":"e_1_3_5_22_2","doi-asserted-by":"publisher","DOI":"10.3389\/fneur.2023.1310327"},{"key":"e_1_3_5_23_2","doi-asserted-by":"publisher","DOI":"10.1038\/s41598-024-84385-1"},{"key":"e_1_3_5_24_2","doi-asserted-by":"publisher","DOI":"10.3389\/fmed.2023.1268252"},{"key":"e_1_3_5_25_2","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0061991"},{"key":"e_1_3_5_26_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.mayocp.2019.05.036"},{"key":"e_1_3_5_27_2","doi-asserted-by":"publisher","DOI":"10.1038\/s41597-022-01899-x"},{"key":"e_1_3_5_28_2","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.39335.541782.AD"},{"key":"e_1_3_5_29_2","doi-asserted-by":"publisher","DOI":"10.1007\/BF01709751"},{"key":"e_1_3_5_30_2","doi-asserted-by":"publisher","DOI":"10.1159\/000521288"},{"key":"e_1_3_5_31_2","doi-asserted-by":"publisher","DOI":"10.3389\/fneur.2023.1125359"},{"key":"e_1_3_5_32_2","doi-asserted-by":"publisher","DOI":"10.1093\/ckj\/sfad034"},{"key":"e_1_3_5_33_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ebiom.2024.105257"},{"key":"e_1_3_5_34_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ebiom.2024.104981"},{"key":"e_1_3_5_35_2","first-page":"661","article-title":"Bicarbonate and serum lab markers as predictors of mortality in the trauma patient","volume":"25","author":"Talbott MM","year":"2024","unstructured":"Talbott MM, Waguespack AN, Armstrong PA, et al. Bicarbonate and serum lab markers as predictors of mortality in the trauma patient. West J Emerg Med. 2024;25:661-667.","journal-title":"West J Emerg Med"},{"key":"e_1_3_5_36_2","doi-asserted-by":"publisher","DOI":"10.1007\/s11255-024-04029-1"},{"key":"e_1_3_5_37_2","doi-asserted-by":"publisher","DOI":"10.1080\/0886022X.2025.2462264"},{"key":"e_1_3_5_38_2","doi-asserted-by":"publisher","DOI":"10.1093\/ckj\/sfae254"},{"key":"e_1_3_5_39_2","doi-asserted-by":"publisher","DOI":"10.1038\/nrneph.2010.33"},{"key":"e_1_3_5_40_2","first-page":"13","article-title":"Pyruvate is a prospective alkalizer to correct hypoxic lactic acidosis","volume":"5","author":"Wang Y","year":"2018","unstructured":"Wang Y, Huang Y, Yang J, Zhou FQ, Zhao L, Zhou H. Pyruvate is a prospective alkalizer to correct hypoxic lactic acidosis. Mil Med Res. 2018;5:13.","journal-title":"Mil Med Res"},{"key":"e_1_3_5_41_2","doi-asserted-by":"publisher","DOI":"10.4110\/in.2023.23.e23"},{"key":"e_1_3_5_42_2","doi-asserted-by":"publisher","DOI":"10.3109\/01902148.2015.1075079"},{"key":"e_1_3_5_43_2","first-page":"605830","article-title":"The use of sodium bicarbonate in the treatment of acidosis in sepsis: a literature update on a long term debate","volume":"2015","author":"Velissaris D","year":"2015","unstructured":"Velissaris D, Karamouzos V, Ktenopoulos N, Pierrakos C, Karanikolas M. The use of sodium bicarbonate in the treatment of acidosis in sepsis: a literature update on a long term debate. Crit Care Res Pract. 2015;2015:605830.","journal-title":"Crit Care Res Pract"},{"key":"e_1_3_5_44_2","doi-asserted-by":"publisher","DOI":"10.1097\/00003246-199202000-00014"},{"key":"e_1_3_5_45_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.pupt.2017.03.002"},{"key":"e_1_3_5_46_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jcrc.2024.154846"},{"key":"e_1_3_5_47_2","first-page":"366","article-title":"Respiratory acidosis","volume":"46","author":"Epstein SK","year":"2001","unstructured":"Epstein SK, Singh N. Respiratory acidosis. Respir Care. 2001;46:366-383.","journal-title":"Respir Care"}],"container-title":["Dose-Response"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/15593258251374417","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/full-xml\/10.1177\/15593258251374417","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/15593258251374417","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,4,28]],"date-time":"2026-04-28T18:02:59Z","timestamp":1777399379000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.sagepub.com\/doi\/10.1177\/15593258251374417"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,7]]},"references-count":46,"journal-issue":{"issue":"3","published-print":{"date-parts":[[2025,7]]}},"alternative-id":["10.1177\/15593258251374417"],"URL":"https:\/\/doi.org\/10.1177\/15593258251374417","relation":{},"ISSN":["1559-3258","1559-3258"],"issn-type":[{"value":"1559-3258","type":"print"},{"value":"1559-3258","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,7]]},"article-number":"15593258251374417"}}