Alkalosis during emergency department evaluation of acute heart failure - Is there an association with mortality?

Sep 14, 2026

Retrospective epidemiologic analysis evaluates whether plasma alkalosis detected in the emergency department among acute heart failure patients relates to in-hospital all-cause mortality. The study uses the EAHFE registry covering 24,248 episodes from 53 Spanish emergency departments, comparing an alkalosis group (pH > 7.45) with controls (pH 7.35–7.45). Logistic regression shows similar mortality between groups and no significant association when stratified by probable metabolic versus respiratory alkalosis.

LanguageEnglish

CategoryResearch & Report

FormatPDF

Pages8

Reading Time20 min

AccessFree to download

Objectives

Methods

Results

Conclusion

ORIGINAL ARTICLE Alkalosis during emergency department evaluation of acute heart failure: Is there an association with mortality? Òscar Miró1,*, María José Fortuny2,*, Begoña Espinosa3, Aitor Alquézar-Arbé4, Javier Jacob5, Joan Carles Trullàs6,7, Oriol Aguiló7,8, Víctor Gil1, Andrea Bellido1, Pere Llorens3 (en nombre del grupo de investigación ICA-SEMES‡) Objectives. To analyze the possible association between a finding of plasma alkalosis in patients diagnosed with acute heart failure (AHF) in the emergency department (ED) and in-hospital mortality. Methods. Cases of AHF were identified in the registry for Epidemiology of Acute Heart Failure in Emergency Departments (EAHFE), which comprises entries for 24 248 episodes diagnosed in 53 Spanish EDs. Studied cases were those with registered plasma pH levels determined by analysis of acid-base equilibrium in the ED. Patients in the alkalosis group (AG) had a plasma pH greater than 7.45. Controls cases had a pH between 7.35 and 7.45. We gathered epidemiologic and comorbidity data, chronic medications, baseline status variables, and characteristics related to the decompensation episode and its severity. The outcome measure was in-hospital mortality from any cause. Logistic regression was used to analyze crude and adjusted associations between alkalosis and mortality, expressed as odds ratios (ORs) and 95% CIs. Results. A total of 2522 AG cases and 8526 controls were studied. Betwee-group differences included age (AG patients were older), number of comorbidities and chronic medications (notably, more loop diuretics in AG patients), and multiple variables related to the AHF episode. In-hospital all-cause mortality was similar (AG, 7.5%; controls, 7.0%): crude and adjusted ORs, 1.062 (95% CI, 0.896-1.259) and 1.023 (95% CI, 0.854-1.225), respectively. In the AG, 676 patients had probable metabolic alkalosis (PCO2 > 40 mmHg) and 937 had probable respiratory alkalosis (PCO2 < 35 mmHg) . Inhospital mortality was 9.3% in the probable metabolic alkalosis subgroup and 6.7% in the probable respiratory alkalosis subgroup: crude and adjusted ORs, 1.258 (95% CI, 0.942-1.681) and 0.919 (95% CI, 0.695-1.215), respectively. Conclusion. This retrospective analysis of cases in the EAHFE registry found no association between alkalosis and higher in-hospital mortality after AHF. Nor were significant associations found when we analyzed mortality related to probable metabolic vs respiratory alkalosis. Keywords: Acute heart failure. Acid-base equilibrium. Alkalosis. Mortality. Emergency department. Relación entre la presencia de alcalosis a la llegada al servicio de urgenciasy la mortalidad durante un episodio de insuficiencia cardiaca aguda Objetivos. Analizar si existe alguna relación entre la presencia de alcalosis en el plasma de los pacientes que son diagnosticados de insuficiencia cardiaca aguda (ICA) en urgencias y la mortalidad intrahospitalaria. Método. Se seleccionaron los pacientes del Registro EAHFE, que incluye 24.248 episodios de ICA diagnosticados en 53 servicios de urgencias españoles, en los que se disponía del pH plasmático determinado en un equilibrio ácido-base realizado en urgencias. El Grupo Alcalosis (GA) lo formaron los pacientes con pH > 7,45 y el Grupo Control (GC) aquellos con pH entre 7,35 y 7,45 . Se recogieron datos epidemiológicos, de comorbilidad, tratamientos crónicos, situación basal y características y gravedad del episodio de descompensación. La variable de resultado fue la mortalidad intrahospitalaria por cualquier causa. Se analizó la relación cruda y ajustada entre alcalosis y mortalidad mediante regresión logística y se expresó como odds ratio (OR) y su intervalo de confianza del 95% . Resultados. Hubo 2.522 pacientes en el GA y 8.526 en el GC, que difirieron en edad (en el GA eran mayores), en numerosas comorbilidades, en los tratamientos crónicos (de forma remarcable, más diuréticos de asa en el GA) y en múltiples variables relacionas con el ep

FAQs

What was the main objective of the study?

To analyze whether plasma alkalosis found during emergency department evaluation in acute heart failure patients is associated with in-hospital mortality.

How were patients categorized as alkalosis or control?

The alkalosis group had plasma pH > 7.45, while controls had pH between 7.35 and 7.45 based on ED acid-base equilibrium testing.

What did the results show about the relationship between alkalosis and mortality?

In-hospital all-cause mortality was similar between groups, with crude and adjusted odds ratios close to 1 and no significant association.

Did the study find differences when alkalosis was divided by type?

No significant associations were observed when analyzing mortality separately for probable metabolic alkalosis versus probable respiratory alkalosis.

Sep 14, 2026

Uploaded by Lucas Martin