Journal article
Baseline serum bicarbonate levels independently predict short-term mortality in critically ill patients with ischaemic cardiogenic shock.
- Wigger O 1 Department of Cardiology, Bern University Hospital, Switzerland.
- Bloechlinger S 1 Department of Cardiology, Bern University Hospital, Switzerland.
- Berger D 3 Department of Intensive Care Medicine, Bern University Hospital, Switzerland.
- Häner J 1 Department of Cardiology, Bern University Hospital, Switzerland.
- Zanchin T 1 Department of Cardiology, Bern University Hospital, Switzerland.
- Windecker S 1 Department of Cardiology, Bern University Hospital, Switzerland.
- Räber L 1 Department of Cardiology, Bern University Hospital, Switzerland.
- Schefold JC 3 Department of Intensive Care Medicine, Bern University Hospital, Switzerland.
- 2017-08-26
Published in:
- European heart journal. Acute cardiovascular care. - 2018
Biomarker
acute heart failure
acute kidney injury
metabolic acidosis
myocardial infarction
prognosis
Bicarbonates
Biomarkers
Cause of Death
Critical Illness
Female
Hospital Mortality
Humans
Intensive Care Units
Male
Middle Aged
Myocardial Infarction
Predictive Value of Tests
Retrospective Studies
Risk Factors
Shock, Cardiogenic
Survival Rate
Time Factors
English
BACKGROUND
Cardiogenic shock is a feared complication of acute myocardial infarction with high mortality rates. Data on the predictive role of acid base dysregulation in this clinical setting are sparse. We therefore embarked on investigating the predictive role of serum bicarbonate in critically ill intensive care unit (ICU) patients with cardiogenic shock.
METHODS
A total of 165 ischaemic cardiogenic shock patients (118 men, aged 68.4 years (interquartile range 59.0-77.4), APACHE II score 26.0 (interquartile range 21.0-29.0), after percutaneous coronary intervention were included in a single-centre analysis. Percutaneous coronary intervention-related data such as left ventricular ejection fraction and laboratory indices were recorded and routine clinical follow-up was obtained at hospital discharge and at one year. All-cause mortality was assessed and data were analysed using univariate and multivariate models.
RESULTS
All-cause mortality was highest (17%) during the first 48 hours following ICU admission (28-day mortality rate 43%). In a multiple regression model, age (hazard ratio (HR) 1.035, 95% confidence interval (CI) 1.011-1.059, P=0.004), APACHE II score (HR 1.036, 95% CI 1.002-1.072, P=0.037) and baseline serum bicarbonate levels (HR 0.93, 95% CI 0.866-0.998, P=0.046) independently predicted 28-day mortality (overall model fit χ2 22.9, P<0.0001). The HR for patients in the lowest baseline serum bicarbonate tertile for 365-day mortality was HR 2.06 (95% CI 1.20-3.53).
CONCLUSIONS
In a large cohort of consecutive cardiogenic shock patients hospitalised in the ICU, low serum bicarbonate levels at admission independently predicted mortality. Given the widespread availability of blood gas analysers in ICUs, we propose baseline serum bicarbonate levels as an additional biomarker for identification and stratification of cardiogenic shock patients at risk.
Cardiogenic shock is a feared complication of acute myocardial infarction with high mortality rates. Data on the predictive role of acid base dysregulation in this clinical setting are sparse. We therefore embarked on investigating the predictive role of serum bicarbonate in critically ill intensive care unit (ICU) patients with cardiogenic shock.
METHODS
A total of 165 ischaemic cardiogenic shock patients (118 men, aged 68.4 years (interquartile range 59.0-77.4), APACHE II score 26.0 (interquartile range 21.0-29.0), after percutaneous coronary intervention were included in a single-centre analysis. Percutaneous coronary intervention-related data such as left ventricular ejection fraction and laboratory indices were recorded and routine clinical follow-up was obtained at hospital discharge and at one year. All-cause mortality was assessed and data were analysed using univariate and multivariate models.
RESULTS
All-cause mortality was highest (17%) during the first 48 hours following ICU admission (28-day mortality rate 43%). In a multiple regression model, age (hazard ratio (HR) 1.035, 95% confidence interval (CI) 1.011-1.059, P=0.004), APACHE II score (HR 1.036, 95% CI 1.002-1.072, P=0.037) and baseline serum bicarbonate levels (HR 0.93, 95% CI 0.866-0.998, P=0.046) independently predicted 28-day mortality (overall model fit χ2 22.9, P<0.0001). The HR for patients in the lowest baseline serum bicarbonate tertile for 365-day mortality was HR 2.06 (95% CI 1.20-3.53).
CONCLUSIONS
In a large cohort of consecutive cardiogenic shock patients hospitalised in the ICU, low serum bicarbonate levels at admission independently predicted mortality. Given the widespread availability of blood gas analysers in ICUs, we propose baseline serum bicarbonate levels as an additional biomarker for identification and stratification of cardiogenic shock patients at risk.
- Language
-
- English
- Open access status
- closed
- Identifiers
-
- DOI 10.1177/2048872616683526
- PMID 28838261
- Persistent URL
- https://folia.unifr.ch/global/documents/239601
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