The significance of metabolic alkalosis on acute decompensated heart failure: the ALCALOTIC study

期刊论文
发表日期：

2024年5月6日

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Joan Carles Trullàs,
Ana Isabel Peláez,
Julio Blázquez,
Anna Sánchez-Biosca,
Manuel Lorenzo López-Reborio,
Prado Salamanca-Bautista,
José María Fernández-Rodríguez,
Miguel Ángel Vázquez-Ronda,
Melitón Francisco Dávila-Ramos,
Humberto Mendoza-Ruiz-De-Zuazu,
José Luís Morales-Rull,
Jesús Olmedo-Llanes,
Pau Llàcer,
Alicia Conde-Martel,
Prado Salamanca Bautista,
Rocío Ruiz-Hueso,
Soraya Domingo,
Mª Victoria Núñez,
Jesús Olmedo,
Carmen Vázquez,
Juan Bosco-López,
Alejandro Peinado,
Juan Antonio Montes,
Jesús Díez-Manglano,
Pablo Martínez-Rodés,
Vanesa Garcés,
Jorge Rubio,
José M. Fernández Rodríguez,
Adrián Argüelles-Curto,
Orla Torrallardona-Murphy,
Meritxell Gavà-Manso,
Alicia Conde-Martel,
José Mª García,
Sonia González,
Melitón F. Dávila,
Rubén Hernández,
Diego José Gudiño,
Humberto Mendoza,
Margarita Carrera,
Joan Carles Trullàs,
Francisco Epelde,
Anna Sánchez-Biosca,
Raquel Becerra,
Mercè Gil,
Paulina Ivanova Massi,
David Chivite,
Francesc Formiga,
Raquel Núñez,
Cristina Pacho,
Anna Contra,
Luis Ceresuela,
José Luís Morales,
Xavi Pla,
Gabriel López,
Julio Blázquez,
Manuel-Lorenzo López-Reboiro,
José López Castro,
María Asenjo,
Paula de Peralta,
Pau Llàcer,
Luis Manzano,
Raúl Antonio Ruiz-Ortega,
Miguel Ángel Vázquez,
Llanos Soler,
Daniel Mesado,
Jesús Casado,
Daniel Abad,
Ana Isabel Peláez Ballesta,
Elena Morcillo-Rodríguez

摘要

Aims

To determine the prevalence and the impact on prognosis of metabolic alkalosis (MA) in patients admitted for acute heart failure (AHF).

Methods and results

The ALCALOTIC is a multicenter, observational cohort study that prospectively included patients admitted for AHF. Patients were classified into four groups according to their acid–base status on admission: acidosis, MA, respiratory alkalosis, and normal pH (reference group for comparison). Primary endpoint was all-cause in-hospital mortality, and secondary endpoints included 30/90-day all-cause mortality, all-cause readmission, and readmission for HF. Associations between endpoints and acid–base alterations were estimated in a multivariate Cox regression model including sex, age, comorbidities, and Barthel index and expressed as hazard ratio (HR) with 95% confidence interval (95% CI). Six hundred sixty-five patients were included (84 years and 57% women), and 40% had acid–base alterations on admission: 188 (28%) acidosis and 78 (12%) alkalosis. The prevalence (95% CI) of MA was 9% (6.8–11.2%). Patients with MA were more women; had fewer comorbidities, better renal function, and higher left ventricle ejection fraction values; and received more treatment with oral acetazolamide during hospitalization and at discharge. MA was not associated with a higher risk of in-hospital mortality and 30/90-day all-cause mortality or readmissions but was associated with a significant increase in readmissions for HF at 30 and 90 days (adjusted HR [95% CI] 3.294 [1.397–7.767], p = 0.006 and 2.314 [1.075–4.978], p = 0.032).

Conclusion

The prevalence of MA in patients admitted for AHF was 9%, and its presence was associated with more readmissions for HF but not with all-cause mortality.

Graphical abstract