Abstract
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.
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Data availability
The data underlying this article will be shared on reasonable request to the corresponding author.
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Acknowledgements
This study was awarded as best oral communication at the national congress of the Spanish Society of Internal Medicine (November 2022, Gijon, Spain).
List of ALCALOTIC study investigators: ANDALUCÍA: Hospital Universitario Virgen Macarena, Sevilla (Prado Salamanca Bautista y Rocío Ruiz Hueso), Hospital Costa del Sol, Marbella (Soraya Domingo y Mª Victoria Núñez), Hospital Comarcal de Antequera, Málaga (Jesús Olmedo y Carmen Vázquez), Hospital Universitario Puerto Real, Cádiz (Juan Bosco López y Alejandro Peinado), Hospital Universitario Torrecárdenas, Almería (Juan Antonio Montes). ARAGON: Hospital Royo Villanova, Zaragoza (Jesús Díez-Manglano y Pablo Martínez Rodés), Hospital Lozano Blesa, Zaragoza (Vanesa Garcés y Jorge Rubio). ASTURIAS: Hospital Cangas del Narcea (José M Fernández Rodríguez y Adrián Argüelles Curto). BALEARES: Hospital de Son Espases, Palma de Mallorca (Orla Torrallardona Murphy y Meritxell Gavà Manso). CANARIAS: Hospital de Gran Canaria Dr. Negrín (Alicia Conde Martel, José Mª García y Sonia González), Hospital La Candelaria, Tenerife (Melitón F Dávila, Rubén Hernández y Diego José Gudiño). CASTILLA y LEON: Complejo Asistencial de Ávila (Humberto Mendoza), Complejo Hospitalario de Soria (Margarita Carrera). CATALUÑA: Hospital de Olot i comarcal de la Garrotxa, Girona (Joan Carles Trullàs), Hospital Parc Taulí de Sabadell, Barcelona (Francisco Epelde), Hospital de l’Esperit Sant, Santa Coloma de Gramanet, Barcelona (Anna Sánchez Biosca y Raquel Becerra), Hospital de San Rafael, Barcelona (Mercè Gil y Paulina Ivanova Massi), Hospital Universitari de Bellvitge, Hospitalet del Llobregat (David Chivite y Francesc Formiga), Hospital Universitari Germans Trias i Pujol, Badalona (Raquel Núñez y Cristina Pacho), Hospital Moises Broggi, Sant Joan Despí (Anna Contra y Luis Ceresuela), Hospital Arnau de Vilanova, Lleida (José Luís Morales), Hospital de Manresa, Barcelona (Xavi Pla y Gabriel López). COMUNIDAD VALENCIANA: Hospital Universitario de Torrevieja, Alicante (Julio Blázquez). GALICIA: Hospital Monforte de Lemos, Lugo (Manuel Lorenzo López Reboiro y José López Castro). MADRID: Hospital Universitario Rey Juan Carlos (María Asenjo y Paula de Peralta), Hospital Universitario Ramón y Cajal, IRYCIS (Pau Llàcer, Luis Manzano, Raúl Antonio Ruiz Ortega), Hospital Universitario Infanta Sofía (Miguel Ángel Vázquez y Llanos Soler), Hospital General de Villalba (Daniel Mesado), Hospital de Getafe (Jesús Casado y Daniel Abad). MURCIA: Hospital Universitario Rafael Méndez, Lorca, Murcia (Ana Isabel Peláez Ballesta y Elena Morcillo Rodríguez).
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This work was supported by the Heart Failure Working Group of the Spanish Society of Internal Medicine.
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The study was carried out in accordance with the Declaration of Helsinki. The study was approved by a central committee, the Clinical Research Ethics Committee of the Dr. Josep Trueta University Hospital in Girona (Spain), by the Ethics Committees of the participating centers, and by the Spanish Agency Medicines and Health Products (AEMPS in the Spanish acronym). The study was also registered in clinicaltrials.gov (Identifier: NCT04740242). An informed consent was obtained from all participating subjects.
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Trullàs, J.C., Peláez, A.I., Blázquez, J. et al. The significance of metabolic alkalosis on acute decompensated heart failure: the ALCALOTIC study. Clin Res Cardiol (2024). https://doi.org/10.1007/s00392-024-02452-z
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DOI: https://doi.org/10.1007/s00392-024-02452-z