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

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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).

Funding

This work was supported by the Heart Failure Working Group of the Spanish Society of Internal Medicine.

Author information

Authors and Affiliations

  1. Internal Medicine Department, Hospital d’Olot i Comarcal de La Garrotxa, Girona, Av Dels Països Catalans, 86, Olot, 17800, Girona, Catalonia, Spain

    Joan Carles Trullàs

  2. Laboratori de Reparació i Regeneració Tissular (TR2Lab), Facultat de Medicina, Universitat de Vic-Universitat Central de Catalunya, Carretera de Roda, 70, Vic, 08500, Barcelona, Catalonia, Spain

    Joan Carles Trullàs

  3. Internal Medicine Department, Hospital Universitario Rafael Méndez, Ctra.N-340, 30813, Lorca, Murcia, Spain

    Ana Isabel Peláez

  4. Internal Medicine Department, Hospital Universitario de Torrevieja, Carretera CV 95, S/N, 03186, Torrevieja, Alicante, Spain

    Julio Blázquez

  5. Internal Medicine Department, Fundació Hospital de L’Esperit Sant, Avinguda Mossèn Josep Pons I Rabadà, S/N, Santa Coloma de Gramenet, 08923, Barcelona, Catalonia, Spain

    Anna Sánchez-Biosca

  6. Internal Medicine Department, Hospital Comarcal Monforte de Lemos, Rúa Corredoira, S/N, Monforte de Lemos, 27400, Lugo, Spain

    Manuel Lorenzo López-Reborio

  7. Internal Medicine Department, Hospital Universitario Virgen Macarena, Universidad de Sevilla, Avenida Dr. Fedriani, 3, 41009, Seville, Spain

    Prado Salamanca-Bautista

  8. Internal Medicine Department, Hospital Carmen y Severo Ochoa, Calle Sienra, 11, Cangas del Narcea, 33800, Asturias, Spain

    José María Fernández-Rodríguez

  9. Internal Medicine Department, Hospital Universitario Infanta Sofía, P.º de Europa, 34, San Sebastián de los Reyes, 28703, Madrid, Spain

    Miguel Ángel Vázquez-Ronda

  10. Internal Medicine Department, Hospital Universitario Nuestra Señora de La Candelaria, Carretera Gerenal del Rosario, 145, 38010, Santa Cruz de Tenerife, Spain

    Melitón Francisco Dávila-Ramos

  11. Internal Medicine Department, Complejo Asistencial de Ávila, Av. Juan Carlos I, S/N, 05071, Ávila, Spain

    Humberto Mendoza-Ruiz-De-Zuazu

  12. Internal Medicine Department, Heart Failure Unit, Hospital Universitari Arnau de Villanova, Institut de Recerca Biomédica (IRBLleida), Avinguda Alcalde Rovira Roure, 80, 25198, Lleida, Catalonia, Spain

    José Luís Morales-Rull

  13. Internal Medicine Department, Hospital de Antequera, Avenida Poeta Muñoz Rojas, S/N, Málaga, 29200, Antequera, Spain

    Jesús Olmedo-Llanes

  14. Internal Medicine Department, Hospital Universitario Ramón y Cajal, IRYCIS, Universidad de Alcalá, M-607, 9, 100, 28034, Madrid, Spain

    Pau Llàcer

  15. Internal Medicine Department, Hospital Universitario de Gran Canaria Dr. Negrín, C. Pl. Barranco de La Ballena, S/N, 35010, Las Palmas de Gran Canaria, Spain

    Alicia Conde-Martel

Authors
  1. Joan Carles Trullàs
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  2. Ana Isabel Peláez
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  3. Julio Blázquez
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  4. Anna Sánchez-Biosca
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  5. Manuel Lorenzo López-Reborio
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  6. Prado Salamanca-Bautista
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  8. Miguel Ángel Vázquez-Ronda
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  11. José Luís Morales-Rull
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  14. Alicia Conde-Martel
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Consortia

on behalf of the ALCALOTIC study investigators

  • 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

Corresponding author

Correspondence to Joan Carles Trullàs.

Ethics declarations

Ethical approval and consent to participate

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.

Conflict of interest

The authors declare no competing interests.

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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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