title: High total carbon dioxide predicts 1-year readmission and death in patients with acute dyspnea.
abstract: BACKGROUND
  Patients with acute dyspnea are a large heterogeneous patient group where initial management is important for outcome.
  
  
  OBJECTIVE
  The objective of the study is to investigate if venous blood gas parameters predict 1-year risk of readmission or death in patients admitted to the emergency department due to acute dyspnea.
  
  
  METHODS
  We studied 283 patients with acute dyspnea and followed them up for 1 year regarding incidence of readmission or death.
  
  
  RESULTS
  In venous blood obtained immediately upon admission levels of total carbon dioxide (TCO2), base excess (BE), potential hydrogen (pH), and partial pressure of carbon dioxide (pCO2) were measured. In Cox proportional hazards models, patients belonging to top and bottom quartiles of TCO2, BE, pH, and pCO2 were compared to patients belonging to the 2 central quartiles and assessed for end point. After adjustment, top (hazard ratio [HR], 1.48; 95% confidence interval [CI], 1.08-2.04; P=.016) and bottom (HR, 1.54; 95% CI, 1.08-2.18; P=.017) quartiles of BE were associated with increased risk of readmission or death. The strongest predictor was top quartile of TCO2 (HR, 1.68; 95% CI, 1.21-2.35; P=.002). In the combined analysis, top quartile of TCO2 remained significantly related to the end point (HR, 1.59; 95% CI, 1.03-2.45; P=.035), whereas BE became nonsignificant. Comorbidities, for example, prevalent chronic obstructive pulmonary disease, did not explain the association. Neither pCO2 nor pH predicted the end point.
  
  
  CONCLUSIONS
  A high value of TCO2 appears to be an easily accessible marker for 1-year readmission or death in patients with acute dyspnea and may thus add clinically important information for risk stratification and follow-up strategies.
authors: Skåne University Hospital Malmö, Clinical Research Centre CRC, SE-205 02 Malmoe, Sweden. Electronic address: nathalie.lund@skane.se.
authors: Nathalie
authors: N
authors: Lund
authors: Skåne University Hospital Malmö, Clinical Research Centre CRC, SE-205 02 Malmoe, Sweden.
authors: Anders
authors: A
authors: Rohlén
authors: Department of Laboratory Medicine Malmoe, Lund University, SE-205 02 Malmoe, Sweden.
authors: Per
authors: P
authors: Simonsson
authors: Skåne University Hospital Malmö, Clinical Research Centre CRC, SE-205 02 Malmoe, Sweden.
authors: Sofia
authors: S
authors: Enhörning
authors: Skåne University Hospital Malmö, Clinical Research Centre CRC, SE-205 02 Malmoe, Sweden.
authors: Torgny
authors: T
authors: Wessman
authors: Skåne University Hospital Malmö, Clinical Research Centre CRC, SE-205 02 Malmoe, Sweden.
authors: Klas
authors: K
authors: Gränsbo
authors: Skåne University Hospital Malmö, Clinical Research Centre CRC, SE-205 02 Malmoe, Sweden.
authors: Olle
authors: O
authors: Melander
mesh_terms: D000208:Acute Disease; D000368:Aged; D015415:Biomarkers / Q000097:blood; D001784:Blood Gas Analysis; D002245:Carbon Dioxide / Q000097:blood*; D004417:Dyspnea / Q000097:blood* / Q000401:mortality; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D010359:Patient Readmission / Q000706:statistics & numerical data*; D011379:Prognosis; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D018570:Risk Assessment / Q000379:methods; D013548:Sweden / Q000453:epidemiology
chemical_list: D015415:Biomarkers; D002245:Carbon Dioxide