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Prognostic effects of arterial carbon dioxide levels in patients hospitalized into the cardiac intensive care unit for acute heart failure
European Heart Journal - Acute Cardiovascular Care ( IF 3.9 ) Pub Date : 2021-01-06 , DOI: 10.1093/ehjacc/zuab001
Takao Kato 1, 2 , Takatoshi Kasai 1, 2, 3, 4, 5 , Shoko Suda 1, 2 , Akihiro Sato 1, 3 , Sayaki Ishiwata 1, 2, 3 , Shoichiro Yatsu 1 , Hiroki Matsumoto 1 , Jun Shitara 1 , Megumi Shimizu 1 , Azusa Murata 1 , Nobuyuki Kagiyama 1, 5 , Masaru Hiki 1 , Yuya Matsue 1, 3 , Ryo Naito 1, 2, 3 , Atsutoshi Takagi 1 , Hiroyuki Daida 1, 5
Affiliation  

Aims Although both hypercapnia and hypocapnia are common in acute heart failure (AHF) patients, routine assessment of arterial blood gas is not recommended. Additionally, no association between hypercapnia and increased mortality has been found, and the prognostic value of hypocapnia in AHF patients remains to be elucidated. In this observational study, we aimed to investigate the relationship between partial pressure of arterial carbon dioxide (PaCO2), especially low PaCO2, and long-term mortality in AHF patients. Methods and results Acute heart failure patients hospitalized in the cardiac intensive care unit of our institution between 2007 and 2011 were screened. All eligible patients were divided into two groups based on the inflection point (i.e. 31.0 mmHg) of the 3-knot cubic spline curve of the hazard ratio (HR), with a PaCO2 of 40 mmHg as a reference. The association between PaCO2 levels and all-cause mortality was assessed using Cox proportional hazards regression models. Among 435 patients with a median follow-up of 1.8 years, 115 (26.4%) died. Adjusted analysis with relevant variables as confounders indicated that PaCO2 <31 mmHg was significantly associated with increased all-cause mortality [HR 1.71, 95% confidence interval (CI) 1.05–2.79; P = 0.032]. When PaCO2 was considered as a continuous variable, the lower was the log-transformed PaCO2, the greater was the increased risk of mortality (HR 0.71, 95% CI 0.52–0.96; P = 0.024). Conclusions In AHF patients, lower PaCO2 at admission was associated with increased long-term mortality risk.

中文翻译:

急性心力衰竭住院患者动脉二氧化碳水平对预后的影响

目的 虽然高碳酸血症和低碳酸血症在急性心力衰竭 (AHF) 患者中都很常见,但不推荐对动脉血气进行常规评估。此外,尚未发现高碳酸血症与死亡率增加之间存在关联,并且 AHF 患者中低碳酸血症的预后价值仍有待阐明。在这项观察性研究中,我们旨在调查动脉二氧化碳分压 (PaCO2),尤其是低 PaCO2 与 AHF 患者长期死亡率之间的关系。方法与结果 筛选2007-2011年在我院心脏重症监护室住院的急性心力衰竭患者。根据风险比(HR)的3结三次样条曲线的拐点(即31.0 mmHg)将所有符合条件的患者分为两组,以 40 mmHg 的 PaCO2 作为参考。使用 Cox 比例风险回归模型评估 PaCO2 水平与全因死亡率之间的关联。在中位随访时间为 1.8 年的 435 名患者中,115 人(26.4%)死亡。以相关变量为混杂因素的调整分析表明,PaCO2 <31 mmHg 与全因死亡率增加显着相关 [HR 1.71,95% 置信区间 (CI) 1.05–2.79;P = 0.032]。当 PaCO2 被视为连续变量时,对数转换后的 PaCO2 越低,死亡风险增加越大(HR 0.71,95% CI 0.52–0.96;P = 0.024)。结论 在 AHF 患者中,入院时较低的 PaCO2 与长期死亡风险增加相关。使用 Cox 比例风险回归模型评估 PaCO2 水平与全因死亡率之间的关联。在中位随访时间为 1.8 年的 435 名患者中,115 人(26.4%)死亡。以相关变量为混杂因素的调整分析表明,PaCO2 <31 mmHg 与全因死亡率增加显着相关 [HR 1.71,95% 置信区间 (CI) 1.05–2.79;P = 0.032]。当 PaCO2 被视为连续变量时,对数转换后的 PaCO2 越低,死亡风险增加越大(HR 0.71,95% CI 0.52–0.96;P = 0.024)。结论 在 AHF 患者中,入院时较低的 PaCO2 与长期死亡风险增加相关。使用 Cox 比例风险回归模型评估 PaCO2 水平与全因死亡率之间的关联。在中位随访时间为 1.8 年的 435 名患者中,115 人(26.4%)死亡。以相关变量为混杂因素的调整分析表明,PaCO2 <31 mmHg 与全因死亡率增加显着相关 [HR 1.71,95% 置信区间 (CI) 1.05–2.79;P = 0.032]。当 PaCO2 被视为连续变量时,对数转换后的 PaCO2 越低,死亡风险增加越大(HR 0.71,95% CI 0.52–0.96;P = 0.024)。结论 在 AHF 患者中,入院时较低的 PaCO2 与长期死亡风险增加相关。以相关变量为混杂因素的调整分析表明,PaCO2 <31 mmHg 与全因死亡率增加显着相关 [HR 1.71,95% 置信区间 (CI) 1.05–2.79;P = 0.032]。当 PaCO2 被视为连续变量时,对数转换后的 PaCO2 越低,死亡风险增加越大(HR 0.71,95% CI 0.52–0.96;P = 0.024)。结论 在 AHF 患者中,入院时较低的 PaCO2 与长期死亡风险增加相关。以相关变量为混杂因素的调整分析表明,PaCO2 <31 mmHg 与全因死亡率增加显着相关 [HR 1.71,95% 置信区间 (CI) 1.05–2.79;P = 0.032]。当 PaCO2 被视为连续变量时,对数转换后的 PaCO2 越低,死亡风险增加越大(HR 0.71,95% CI 0.52–0.96;P = 0.024)。结论 在 AHF 患者中,入院时较低的 PaCO2 与长期死亡风险增加相关。024)。结论 在 AHF 患者中,入院时较低的 PaCO2 与长期死亡风险增加相关。024)。结论 在 AHF 患者中,入院时较低的 PaCO2 与长期死亡风险增加相关。
更新日期:2021-01-06
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