Prognostic Value of Lactate, Standard Base Excess, and Alactic Base Excess in Sepsis and Septic Shock: A Retrospective Cohort Study

Sepsis and septic shock are severe medical conditions associated with high morbidity and mortality, necessitating accurate risk stratification to optimize clinical management. Lactate is a well-established biomarker for sepsis prognosis, reflecting tissue hypoxia and anaerobic metabolism. Standard Base Excess (SBE) is commonly used to assess metabolic acidosis, but its prognostic value in sepsis remains uncertain, particularly in the presence of elevated lactate levels. Alactic Base Excess (aBE), calculated as SBE + lactate, has been proposed as an alternative marker to differentiate non-lactate metabolic derangements. This retrospective cohort study aimed to compare the prognostic accuracy of lactate, SBE, and aBE in predicting mortality among patients with sepsis and septic shock. A total of 218 patients admitted to the intensive care unit (ICU) were analyzed, including 90 survivors and 128 non-survivors. Elevated lactate levels were significantly associated with mortality (p < 0.001) and remained an independent predictor in multivariate analysis (odds ratio [OR]: 1.40, 95% confidence interval [CI]: 1.11–1.77, p = 0.005). SBE showed a weak association with mortality in univariate analysis but lost significance in multivariate models. ABE did not demonstrate significant prognostic value. Receiver Operating Characteristic (ROC) analysis confirmed lactate as the most reliable predictor, with an area under the curve (AUC) of 0.742. These findings suggest that lactate remains the superior prognostic biomarker in sepsis and septic shock, whereas SBE and aBE do not provide additional predictive value. Further research is needed to explore the dynamic changes in these biomarkers over time to refine risk stratification in septic patients.