Prognostic value of base excess as indicator of acid-base balance in acute heart failure
Background: Acid-base balance can change as a result of pulmonary oedema and low tissue perfusion in acute heart failure patients. However, its long-term prognostic significance remains to be clarified. Methods: We prospectively examined a cohort of 472 consecutive acute heart failure patients who u...
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| Veröffentlicht in: | European heart journal. Acute cardiovascular care 2020-08, Vol.9 (5), p.399-405 |
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| creator | Nakano, Hiroki Nagai, Toshiyuki Honda, Yasuyuki Honda, Satoshi Iwakami, Naotsugu Matsumoto, Chisa Asaumi, Yasuhide Aiba, Takeshi Noguchi, Teruo Kusano, Kengo Yokoyama, Hiroyuki Ogawa, Hisao Yasuda, Satoshi Chikamori, Taishiro Anzai, Toshihisa |
| description | Background:
Acid-base balance can change as a result of pulmonary oedema and low tissue perfusion in acute heart failure patients. However, its long-term prognostic significance remains to be clarified.
Methods:
We prospectively examined a cohort of 472 consecutive acute heart failure patients who underwent arterial blood gas analysis on admission between January 2013 and May 2016. Acidaemia, alkalaemia and normal range of base excess were defined as pH 7.42 and −2 to 2 mEq/L, respectively. The primary outcome was all-cause death.
Results:
During a median follow-up period of 714 days, 101 patients died. Although there was no difference in mortality among patients with acidaemia, normal pH and alkalaemia (p = 0.92), patients with high base excess had the highest mortality compared with others. Multivariable Cox proportional hazard models revealed that high base excess was an independent determinant of mortality (hazard ratio 1.83, 95% confidence interval 1.08–3.13 (high versus normal base excess), hazard ratio 0.81, 95% confidence interval 0.47–1.41 (low versus normal base excess)), even after adjustment for significant prognostic covariates. Furthermore, regarding mortality stratified by base excess and carbon dioxide partial pressure (pCO2), patients with high base excess (>2.1 mEq/L) and high pCO2 (>40 mmHg) had the highest mortality compared with others.
Conclusions:
High base excess, but not low base excess, on admission was associated with long-term mortality in acute heart failure patients, indicating the importance of evaluating acid-base balance on admission by base excess for stratifying the risk of mortality in patients with acute heart failure. |
| doi_str_mv | 10.1177/2048872619898781 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_2344231111</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sage_id>10.1177_2048872619898781</sage_id><sourcerecordid>2344231111</sourcerecordid><originalsourceid>FETCH-LOGICAL-c445t-7a3ee4c9781756be147d0fa649f65b4ff464126716328f00370ee6e224df866e3</originalsourceid><addsrcrecordid>eNp1kE1LAzEQhoMottTePUmOXlbz1SR7lOIXCHpQ8LZks5O6ZbupyUb035va2oPgXGaYeeZl5kXolJILSpW6ZERorZikpS610vQAjTetQisuDvc1kyM0jXFJcigihebHaMRpqUhZ8jF6fQp-0fs4tBZ_mC4B9g7XJgKGTwsxYhNx2zetNYMPm5mxbVP8ALXpTG8hj3MzDYDfwIQBO9N2KcAJOnKmizDd5Ql6ubl-nt8VD4-39_Orh8IKMRsKZTiAsGW-X81kDVSohjgjRenkrBbOCSkok4pKzrQjhCsCIIEx0TgtJfAJOt_qroN_TxCHatVGC12-DXyKFeNCME5zZJRsURt8jAFctQ7tyoSvipJqY2n119K8crZTT_UKmv3Cr4EZKLZANAuolj6FPn_7v-A3omB8lA</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2344231111</pqid></control><display><type>article</type><title>Prognostic value of base excess as indicator of acid-base balance in acute heart failure</title><source>Access via SAGE</source><source>MEDLINE</source><source>Oxford University Press Journals All Titles (1996-Current)</source><creator>Nakano, Hiroki ; Nagai, Toshiyuki ; Honda, Yasuyuki ; Honda, Satoshi ; Iwakami, Naotsugu ; Matsumoto, Chisa ; Asaumi, Yasuhide ; Aiba, Takeshi ; Noguchi, Teruo ; Kusano, Kengo ; Yokoyama, Hiroyuki ; Ogawa, Hisao ; Yasuda, Satoshi ; Chikamori, Taishiro ; Anzai, Toshihisa</creator><creatorcontrib>Nakano, Hiroki ; Nagai, Toshiyuki ; Honda, Yasuyuki ; Honda, Satoshi ; Iwakami, Naotsugu ; Matsumoto, Chisa ; Asaumi, Yasuhide ; Aiba, Takeshi ; Noguchi, Teruo ; Kusano, Kengo ; Yokoyama, Hiroyuki ; Ogawa, Hisao ; Yasuda, Satoshi ; Chikamori, Taishiro ; Anzai, Toshihisa</creatorcontrib><description>Background:
Acid-base balance can change as a result of pulmonary oedema and low tissue perfusion in acute heart failure patients. However, its long-term prognostic significance remains to be clarified.
Methods:
We prospectively examined a cohort of 472 consecutive acute heart failure patients who underwent arterial blood gas analysis on admission between January 2013 and May 2016. Acidaemia, alkalaemia and normal range of base excess were defined as pH <7.38, >7.42 and −2 to 2 mEq/L, respectively. The primary outcome was all-cause death.
Results:
During a median follow-up period of 714 days, 101 patients died. Although there was no difference in mortality among patients with acidaemia, normal pH and alkalaemia (p = 0.92), patients with high base excess had the highest mortality compared with others. Multivariable Cox proportional hazard models revealed that high base excess was an independent determinant of mortality (hazard ratio 1.83, 95% confidence interval 1.08–3.13 (high versus normal base excess), hazard ratio 0.81, 95% confidence interval 0.47–1.41 (low versus normal base excess)), even after adjustment for significant prognostic covariates. Furthermore, regarding mortality stratified by base excess and carbon dioxide partial pressure (pCO2), patients with high base excess (>2.1 mEq/L) and high pCO2 (>40 mmHg) had the highest mortality compared with others.
Conclusions:
High base excess, but not low base excess, on admission was associated with long-term mortality in acute heart failure patients, indicating the importance of evaluating acid-base balance on admission by base excess for stratifying the risk of mortality in patients with acute heart failure.</description><identifier>ISSN: 2048-8726</identifier><identifier>EISSN: 2048-8734</identifier><identifier>DOI: 10.1177/2048872619898781</identifier><identifier>PMID: 31970993</identifier><language>eng</language><publisher>London, England: SAGE Publications</publisher><subject>Acid-Base Equilibrium ; Acute Disease ; Aged ; Biomarkers - blood ; Female ; Follow-Up Studies ; Heart Failure - blood ; Heart Failure - diagnosis ; Humans ; Male ; Prognosis ; Prospective Studies ; Registries ; Time Factors</subject><ispartof>European heart journal. Acute cardiovascular care, 2020-08, Vol.9 (5), p.399-405</ispartof><rights>The European Society of Cardiology 2020</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c445t-7a3ee4c9781756be147d0fa649f65b4ff464126716328f00370ee6e224df866e3</citedby><cites>FETCH-LOGICAL-c445t-7a3ee4c9781756be147d0fa649f65b4ff464126716328f00370ee6e224df866e3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://journals.sagepub.com/doi/pdf/10.1177/2048872619898781$$EPDF$$P50$$Gsage$$H</linktopdf><linktohtml>$$Uhttps://journals.sagepub.com/doi/10.1177/2048872619898781$$EHTML$$P50$$Gsage$$H</linktohtml><link.rule.ids>314,780,784,21819,27924,27925,43621,43622</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/31970993$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Nakano, Hiroki</creatorcontrib><creatorcontrib>Nagai, Toshiyuki</creatorcontrib><creatorcontrib>Honda, Yasuyuki</creatorcontrib><creatorcontrib>Honda, Satoshi</creatorcontrib><creatorcontrib>Iwakami, Naotsugu</creatorcontrib><creatorcontrib>Matsumoto, Chisa</creatorcontrib><creatorcontrib>Asaumi, Yasuhide</creatorcontrib><creatorcontrib>Aiba, Takeshi</creatorcontrib><creatorcontrib>Noguchi, Teruo</creatorcontrib><creatorcontrib>Kusano, Kengo</creatorcontrib><creatorcontrib>Yokoyama, Hiroyuki</creatorcontrib><creatorcontrib>Ogawa, Hisao</creatorcontrib><creatorcontrib>Yasuda, Satoshi</creatorcontrib><creatorcontrib>Chikamori, Taishiro</creatorcontrib><creatorcontrib>Anzai, Toshihisa</creatorcontrib><title>Prognostic value of base excess as indicator of acid-base balance in acute heart failure</title><title>European heart journal. Acute cardiovascular care</title><addtitle>Eur Heart J Acute Cardiovasc Care</addtitle><description>Background:
Acid-base balance can change as a result of pulmonary oedema and low tissue perfusion in acute heart failure patients. However, its long-term prognostic significance remains to be clarified.
Methods:
We prospectively examined a cohort of 472 consecutive acute heart failure patients who underwent arterial blood gas analysis on admission between January 2013 and May 2016. Acidaemia, alkalaemia and normal range of base excess were defined as pH <7.38, >7.42 and −2 to 2 mEq/L, respectively. The primary outcome was all-cause death.
Results:
During a median follow-up period of 714 days, 101 patients died. Although there was no difference in mortality among patients with acidaemia, normal pH and alkalaemia (p = 0.92), patients with high base excess had the highest mortality compared with others. Multivariable Cox proportional hazard models revealed that high base excess was an independent determinant of mortality (hazard ratio 1.83, 95% confidence interval 1.08–3.13 (high versus normal base excess), hazard ratio 0.81, 95% confidence interval 0.47–1.41 (low versus normal base excess)), even after adjustment for significant prognostic covariates. Furthermore, regarding mortality stratified by base excess and carbon dioxide partial pressure (pCO2), patients with high base excess (>2.1 mEq/L) and high pCO2 (>40 mmHg) had the highest mortality compared with others.
Conclusions:
High base excess, but not low base excess, on admission was associated with long-term mortality in acute heart failure patients, indicating the importance of evaluating acid-base balance on admission by base excess for stratifying the risk of mortality in patients with acute heart failure.</description><subject>Acid-Base Equilibrium</subject><subject>Acute Disease</subject><subject>Aged</subject><subject>Biomarkers - blood</subject><subject>Female</subject><subject>Follow-Up Studies</subject><subject>Heart Failure - blood</subject><subject>Heart Failure - diagnosis</subject><subject>Humans</subject><subject>Male</subject><subject>Prognosis</subject><subject>Prospective Studies</subject><subject>Registries</subject><subject>Time Factors</subject><issn>2048-8726</issn><issn>2048-8734</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2020</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp1kE1LAzEQhoMottTePUmOXlbz1SR7lOIXCHpQ8LZks5O6ZbupyUb035va2oPgXGaYeeZl5kXolJILSpW6ZERorZikpS610vQAjTetQisuDvc1kyM0jXFJcigihebHaMRpqUhZ8jF6fQp-0fs4tBZ_mC4B9g7XJgKGTwsxYhNx2zetNYMPm5mxbVP8ALXpTG8hj3MzDYDfwIQBO9N2KcAJOnKmizDd5Ql6ubl-nt8VD4-39_Orh8IKMRsKZTiAsGW-X81kDVSohjgjRenkrBbOCSkok4pKzrQjhCsCIIEx0TgtJfAJOt_qroN_TxCHatVGC12-DXyKFeNCME5zZJRsURt8jAFctQ7tyoSvipJqY2n119K8crZTT_UKmv3Cr4EZKLZANAuolj6FPn_7v-A3omB8lA</recordid><startdate>202008</startdate><enddate>202008</enddate><creator>Nakano, Hiroki</creator><creator>Nagai, Toshiyuki</creator><creator>Honda, Yasuyuki</creator><creator>Honda, Satoshi</creator><creator>Iwakami, Naotsugu</creator><creator>Matsumoto, Chisa</creator><creator>Asaumi, Yasuhide</creator><creator>Aiba, Takeshi</creator><creator>Noguchi, Teruo</creator><creator>Kusano, Kengo</creator><creator>Yokoyama, Hiroyuki</creator><creator>Ogawa, Hisao</creator><creator>Yasuda, Satoshi</creator><creator>Chikamori, Taishiro</creator><creator>Anzai, Toshihisa</creator><general>SAGE Publications</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>202008</creationdate><title>Prognostic value of base excess as indicator of acid-base balance in acute heart failure</title><author>Nakano, Hiroki ; Nagai, Toshiyuki ; Honda, Yasuyuki ; Honda, Satoshi ; Iwakami, Naotsugu ; Matsumoto, Chisa ; Asaumi, Yasuhide ; Aiba, Takeshi ; Noguchi, Teruo ; Kusano, Kengo ; Yokoyama, Hiroyuki ; Ogawa, Hisao ; Yasuda, Satoshi ; Chikamori, Taishiro ; Anzai, Toshihisa</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c445t-7a3ee4c9781756be147d0fa649f65b4ff464126716328f00370ee6e224df866e3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2020</creationdate><topic>Acid-Base Equilibrium</topic><topic>Acute Disease</topic><topic>Aged</topic><topic>Biomarkers - blood</topic><topic>Female</topic><topic>Follow-Up Studies</topic><topic>Heart Failure - blood</topic><topic>Heart Failure - diagnosis</topic><topic>Humans</topic><topic>Male</topic><topic>Prognosis</topic><topic>Prospective Studies</topic><topic>Registries</topic><topic>Time Factors</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Nakano, Hiroki</creatorcontrib><creatorcontrib>Nagai, Toshiyuki</creatorcontrib><creatorcontrib>Honda, Yasuyuki</creatorcontrib><creatorcontrib>Honda, Satoshi</creatorcontrib><creatorcontrib>Iwakami, Naotsugu</creatorcontrib><creatorcontrib>Matsumoto, Chisa</creatorcontrib><creatorcontrib>Asaumi, Yasuhide</creatorcontrib><creatorcontrib>Aiba, Takeshi</creatorcontrib><creatorcontrib>Noguchi, Teruo</creatorcontrib><creatorcontrib>Kusano, Kengo</creatorcontrib><creatorcontrib>Yokoyama, Hiroyuki</creatorcontrib><creatorcontrib>Ogawa, Hisao</creatorcontrib><creatorcontrib>Yasuda, Satoshi</creatorcontrib><creatorcontrib>Chikamori, Taishiro</creatorcontrib><creatorcontrib>Anzai, Toshihisa</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>European heart journal. Acute cardiovascular care</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Nakano, Hiroki</au><au>Nagai, Toshiyuki</au><au>Honda, Yasuyuki</au><au>Honda, Satoshi</au><au>Iwakami, Naotsugu</au><au>Matsumoto, Chisa</au><au>Asaumi, Yasuhide</au><au>Aiba, Takeshi</au><au>Noguchi, Teruo</au><au>Kusano, Kengo</au><au>Yokoyama, Hiroyuki</au><au>Ogawa, Hisao</au><au>Yasuda, Satoshi</au><au>Chikamori, Taishiro</au><au>Anzai, Toshihisa</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Prognostic value of base excess as indicator of acid-base balance in acute heart failure</atitle><jtitle>European heart journal. Acute cardiovascular care</jtitle><addtitle>Eur Heart J Acute Cardiovasc Care</addtitle><date>2020-08</date><risdate>2020</risdate><volume>9</volume><issue>5</issue><spage>399</spage><epage>405</epage><pages>399-405</pages><issn>2048-8726</issn><eissn>2048-8734</eissn><abstract>Background:
Acid-base balance can change as a result of pulmonary oedema and low tissue perfusion in acute heart failure patients. However, its long-term prognostic significance remains to be clarified.
Methods:
We prospectively examined a cohort of 472 consecutive acute heart failure patients who underwent arterial blood gas analysis on admission between January 2013 and May 2016. Acidaemia, alkalaemia and normal range of base excess were defined as pH <7.38, >7.42 and −2 to 2 mEq/L, respectively. The primary outcome was all-cause death.
Results:
During a median follow-up period of 714 days, 101 patients died. Although there was no difference in mortality among patients with acidaemia, normal pH and alkalaemia (p = 0.92), patients with high base excess had the highest mortality compared with others. Multivariable Cox proportional hazard models revealed that high base excess was an independent determinant of mortality (hazard ratio 1.83, 95% confidence interval 1.08–3.13 (high versus normal base excess), hazard ratio 0.81, 95% confidence interval 0.47–1.41 (low versus normal base excess)), even after adjustment for significant prognostic covariates. Furthermore, regarding mortality stratified by base excess and carbon dioxide partial pressure (pCO2), patients with high base excess (>2.1 mEq/L) and high pCO2 (>40 mmHg) had the highest mortality compared with others.
Conclusions:
High base excess, but not low base excess, on admission was associated with long-term mortality in acute heart failure patients, indicating the importance of evaluating acid-base balance on admission by base excess for stratifying the risk of mortality in patients with acute heart failure.</abstract><cop>London, England</cop><pub>SAGE Publications</pub><pmid>31970993</pmid><doi>10.1177/2048872619898781</doi><tpages>7</tpages><oa>free_for_read</oa></addata></record> |
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| ispartof | European heart journal. Acute cardiovascular care, 2020-08, Vol.9 (5), p.399-405 |
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| subjects | Acid-Base Equilibrium Acute Disease Aged Biomarkers - blood Female Follow-Up Studies Heart Failure - blood Heart Failure - diagnosis Humans Male Prognosis Prospective Studies Registries Time Factors |
| title | Prognostic value of base excess as indicator of acid-base balance in acute heart failure |
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