1 Department of Cardiology, Bern University Hospital, Switzerland.
2 Department of Intensive Care Medicine, Bern University Hospital, Switzerland.
Eur Heart J Acute Cardiovasc Care. 2018 Feb;7(1):45-52. doi: 10.1177/2048872616683526. Epub 2016 Dec 14.
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.
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.
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 χ 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).
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.
心源性休克是急性心肌梗死的一种严重并发症，死亡率很高。关于酸碱失衡在这种临床情况下的预测作用的数据很少。因此，我们着手研究血清碳酸氢盐在重症监护病房（ICU）心源性休克危重症患者中的预测作用。
共纳入 165 例缺血性心源性休克患者（男性 118 例，年龄 68.4 岁（四分位间距 59.0-77.4），APACHE II 评分 26.0（四分位间距 21.0-29.0），经皮冠状动脉介入治疗后）进行单中心分析。记录经皮冠状动脉介入治疗相关数据，如左心室射血分数和实验室指标，并在出院和 1 年时进行常规临床随访。评估全因死亡率，并使用单变量和多变量模型进行数据分析。
ICU 入院后 48 小时内死亡率最高（17%）（28 天死亡率 43%）。在多变量回归模型中，年龄（危险比（HR）1.035，95%置信区间（CI）1.011-1.059，P=0.004）、APACHE II 评分（HR 1.036，95%CI 1.002-1.072，P=0.037）和基线血清碳酸氢盐水平（HR 0.93，95%CI 0.866-0.998，P=0.046）独立预测 28 天死亡率（总体模型拟合χ 22.9，P<0.0001）。在 365 天死亡率的最低基线血清碳酸氢盐三分位组中，HR 为 2.06（95%CI 1.20-3.53）。
在 ICU 住院的大量连续心源性休克患者中，入院时的低血清碳酸氢盐水平独立预测死亡率。鉴于血气分析仪在 ICU 中的广泛应用，我们建议将基线血清碳酸氢盐水平作为一种额外的生物标志物，用于识别和分层心源性休克患者的风险。
