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

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...

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Published in:	Clinical research in cardiology Vol. 113; no. 8; pp. 1251 - 1262
Main Authors:	Trullàs, Joan Carles, Peláez, Ana Isabel, Blázquez, Julio, Sánchez-Biosca, Anna, López-Reborio, Manuel Lorenzo, Salamanca-Bautista, Prado, Fernández-Rodríguez, José María, Vázquez-Ronda, Miguel Ángel, Dávila-Ramos, Melitón Francisco, Mendoza-Ruiz-De-Zuazu, Humberto, Morales-Rull, José Luís, Olmedo-Llanes, Jesús, Llàcer, Pau, Conde-Martel, Alicia, Salamanca Bautista, Prado, Ruiz-Hueso, Rocío, Domingo, Soraya, Núñez, Mª Victoria, Olmedo, Jesús, Vázquez, Carmen, Bosco-López, Juan, Peinado, Alejandro, Montes, Juan Antonio, Díez-Manglano, Jesús, Martínez-Rodés, Pablo, Garcés, Vanesa, Rubio, Jorge, Fernández Rodríguez, José M., Argüelles-Curto, Adrián, Torrallardona-Murphy, Orla, Gavà-Manso, Meritxell, García, José Mª, González, Sonia, Dávila, Melitón F., Hernández, Rubén, Gudiño, Diego José, Mendoza, Humberto, Carrera, Margarita, Epelde, Francisco, Becerra, Raquel, Gil, Mercè, Massi, Paulina Ivanova, Chivite, David, Formiga, Francesc, Núñez, Raquel, Pacho, Cristina, Contra, Anna, Ceresuela, Luis, Morales, José Luís, Pla, Xavi, López, Gabriel, López-Reboiro, Manuel-Lorenzo, Castro, José López, Asenjo, María, de Peralta, Paula, Manzano, Luis, Ruiz-Ortega, Raúl Antonio, Vázquez, Miguel Ángel, Soler, Llanos, Mesado, Daniel, Casado, Jesús, Abad, Daniel, Peláez Ballesta, Ana Isabel, Morcillo-Rodríguez, Elena
Format:	Journal Article
Language:	English
Published:	Berlin/Heidelberg Springer Berlin Heidelberg 01-08-2024 Springer Nature B.V
Subjects:	Acetazolamide Acidosis Acute Disease Aged Aged, 80 and over Alkalosis Alkalosis - epidemiology Cardiology Comorbidity Congestive heart failure Female Germany - epidemiology Heart failure Heart Failure - epidemiology Heart Failure - mortality Heart Failure - physiopathology Hospital Mortality Hospitals Humans Male Medicine Medicine & Public Health Metabolism Mortality Observational studies Original Paper Patient Readmission - statistics & numerical data Patients Prevalence Prognosis Prospective Studies Regression models Renal function Risk Factors Sex ratio Statistical analysis Time Factors Germany Heart failure Diuretics Acid–base equilibrium Acute heart failure Alkalosis
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Summary:	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
Bibliography:	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23 ObjectType-Undefined-3
ISSN:	1861-0684 1861-0692 1861-0692
DOI:	10.1007/s00392-024-02452-z