ArticleCritical care and resuscitation : journal of the Australasian Academy of Critical Care Medicine2026
Extreme acidosis in hospitalised patients: A 10-year single-centre, retrospective analysis.
Article in Critical care and resuscitation : journal of the Australasian Academy of Critical Care Medicine, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Objective: Acidaemia is a commonly occurring abnormality of acid-base balance. The literature assessing extreme acidosis (pH ≤ 7) is limited and is largely focused on those admitted to intensive care. Therefore, we sought to review the demographics, aetiologies, and outcomes of all hospitalised patients with extreme acidosis. Design and Setting: This was a retrospective cohort study conducted at a single centre, tertiary hospital in Melbourne, Australia Results: Between June 2015 and June 2025, 162,697 patients had 451,788 multi-day admissions. Five hundred eighty-six admissions were identified, in which a patient had a measured pH ≤ 7.0. The final cohort consisted of 493 first admission episodes. Three hundred twenty-four (68.5 %) were male with a median age of 59.3 (interquartile range: 41.2-71.7). By day 30, 226 (45.8 %) of patients had died. Mixed acidosis (321, 65.1 %) and cardiorespiratory arrest (160, 32.5 %) were the most frequently occurring type and aetiology of acidosis. Relative to metabolic acidosis, both mixed acidosis (adjusted hazard ratio (aHR): 2.25, 95 % CI: 1.55-3.27) and respiratory acidosis (aHR: 2.08, 95 % CI: 1.01-4.27) had a higher hazard of 30-day mortality. Causes associated with the highest risk of 30-day mortality were vascular (aHR: 31.2, 95 % CI: 9.60-101) and cardiorespiratory arrest (aHR: 27.0, 95 % CI: 9.17-79.4). One hundred nine (22.1 %) patients did not require intensive care unit admission; however, 37 (33.9 %) of these patients still had died by day 30. Conclusions: Extreme acidosis is extremely rare in hospitalised inpatients. Mortality varies according to type and aetiology of the cause of acidosis and therefore careful consideration as to the implications of extreme acidosis when considering cessation of treatment is crucial.
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