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- Title
The prognostic value of arterial blood gas analysis in high-risk acute heart failure patients: an analysis of the Korean Heart Failure ( KorHF) registry.
- Authors
Park, Jin Joo; Choi, Dong‐Ju; Yoon, Chang‐Hwan; Oh, Il‐Young; Lee, Ju Hyun; Ahn, Soyeon; Yoo, Byung‐Su; Kang, Seok‐Min; Kim, Jae‐Joong; Baek, Sang‐Hong; Cho, Myeong‐Chan; Jeon, Eun‐Seok; Chae, Shung Chull; Ryu, Kyu‐Hyung; Oh, Byung‐Hee
- Abstract
Aims In acute heart failure ( AHF) patients, pulmonary oedema and low tissue perfusion may lead to changes in the acid-base balance, which may be associated with worse outcomes. Methods and results In this prospective nationwide cohort study from 24 academic hospitals, arterial blood gas ( ABG) was measured in 1982 AHF patients at hospital admission. Acidosis was defined as pH <7.36, and alkalosis as pH >7.44. Mortality was stratified according to ABG results. Overall, 19% had acidosis, 37% had normal pH, and 44% had alkalosis. The most common type of acidosis was the mixed type (42%) followed by metabolic acidosis (40%), and the most common type of alkalosis was respiratory alkalosis (58%). At 12 months' follow-up 304 patients (15%) died. Patients with acidosis had higher mortality (acidosis 19.5%, neutral pH 13.7%, alkalosis 14.9%; P = 0.007). In the Cox proportional-hazards regression model, acidosis was a significant predictor of mortality (hazard ratio 1.93; 95% confidence intervals 1.27-2.93) along with N-terminal pro-brain type natriuretic peptide ( NT-proBNP), among others. In contrast, alkalosis was not associated with increased mortality. pH had an incremental prognostic value over NT-proBNP (net reclassification improvement 30%; P < 0.001), and ABG analysis identified extra patients at increased risk for mortality among patients with an NT-proBNP level less than the median (12-month mortality 17.5% vs. 9.9%; P = 0.009). Conclusion In high-risk AHF patients, the most common acid-base imbalance is respiratory alkalosis. Acidosis is observed in every fifth patient and is a significant predictor of mortality. pH provides an additional prognostic value and may be used to optimize risk stratification in high-risk AHF patients.
- Subjects
BLOOD gases analysis; HEART failure; DISEASE risk factors; HEART failure patients; KOREANS; HEALTH; PROGNOSIS
- Publication
European Journal of Heart Failure, 2015, Vol 17, Issue 6, p601
- ISSN
1388-9842
- Publication type
Article
- DOI
10.1002/ejhf.276