title: Clinical significance of acid-base balance in an emergency setting in patients with acute heart failure.
abstract: OBJECTIVE
  The role of an arterial blood gas analysis in acute heart failure (AHF) remains unclear. The acid-base balance could help to treat AHF, and it might help to distinguish different types of AHF, while it might be associated with the AHF prognosis. The present study was conducted to determine the relationship between the arterial blood gas sample at the time of hospital admission and clinical findings on admission, outcomes.
  
  
  RESULTS
  Six hundred twenty-one patients with AHF admitted to the intensive care unit were analyzed. Patients were assigned to an alkalosis group (n=99, pH>7.45), normal group (n=178, 7.35≤ pH≤ 7.45), and acidosis group (n=344, pH<7.35). The clinical findings on admission and outcomes (in-hospital mortality and any-cause death within 2 years) were compared between the three groups. The white blood cell counts (WBC), serum levels of total protein, albumin, and glucose were significantly lower, and the serum levels of C-reactive protein (CRP) and total bilirubin were significantly higher in the alkalosis group. Patients with orthopnea were significantly fewer, and the systolic blood pressure (SBP) and heart rate (HR) were significantly lower in the alkalosis group. The results of a multivariate logistic regression model for in-hospital mortality found that alkalosis was an independent risk factor (p=0.017, odds ratio: 2.589; 95% confidence interval: 1.186-5.648). The Kaplan-Meier curves showed the prognosis for any-cause death to be significantly poorer in the alkalosis group than in the normal group (p=0.026).
  
  
  CONCLUSIONS
  The factors associated with alkalosis AHF were high CRP, bilirubin, and low WBC, glucose, total protein, and albumin. The patients with alkalosis AHF were less likely to have orthopnea with low SBP and HR. They suggested that the patients with alkalosis AHF might have experienced AHF for a few days and were associated with high mortality.
authors: Division of Intensive Care Unit, Chiba Hokusoh Hospital, Nippon Medical School, Chiba, Japan. s6042@nms.ac.jp
authors: Akihiro
authors: A
authors: Shirakabe
authors: Noritake
authors: N
authors: Hata
authors: Nobuaki
authors: N
authors: Kobayashi
authors: Takuro
authors: T
authors: Shinada
authors: Kazunori
authors: K
authors: Tomita
authors: Masafumi
authors: M
authors: Tsurumi
authors: Masato
authors: M
authors: Matsushita
authors: Hirotake
authors: H
authors: Okazaki
authors: Yoshiya
authors: Y
authors: Yamamoto
authors: Shinya
authors: S
authors: Yokoyama
authors: Kuniya
authors: K
authors: Asai
authors: Kyoichi
authors: K
authors: Mizuno
mesh_terms: D000136:Acid-Base Equilibrium / Q000502:physiology*; D000208:Acute Disease; D000368:Aged; D001158:Arteries; D001784:Blood Gas Analysis; D004630:Emergencies; D005260:Female; D006333:Heart Failure / Q000097:blood / Q000401:mortality*; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D011379:Prognosis