Department of Anesthesiology, Harbin Medical University Cancer Hospital, Harbin, China.
Department of Anesthesiology, Dazhou Central Hospital, Dazhou, China.
ESC Heart Fail. 2024 Aug;11(4):2138-2147. doi: 10.1002/ehf2.14763. Epub 2024 Apr 11.
Both hypercapnia and hypocapnia are common in patients with acute heart failure (AHF), but the association between partial pressure of arterial carbon dioxide (PaCO) and AHF prognosis remains unclear. The objective of this study was to investigate the connection between PaCO within 24 h after admission to the intensive care unit (ICU) and mortality during hospitalization and at 1 year in AHF patients.
AHF patients were enrolled from the Medical Information Mart for Intensive Care IV database. The patients were divided into three groups by PaCO values of <35, 35-45, and >45 mmHg. The primary outcome was to investigate the connection between PaCO and in-hospital mortality and 1 year mortality in AHF patients. The secondary outcome was to assess the prediction value of PaCO in predicting in-hospital mortality and 1 year mortality in AHF patients. A total of 2374 patients were included in this study, including 457 patients in the PaCO < 35 mmHg group, 1072 patients in the PaCO = 35-45 mmHg group, and 845 patients in the PaCO > 45 mmHg group. The in-hospital mortality was 19.5%, and the 1 year mortality was 23.9% in the PaCO < 35 mmHg group. Multivariate logistic regression analysis showed that the PaCO < 35 mmHg group was associated with an increased risk of in-hospital mortality [hazard ratio (HR) 1.398, 95% confidence interval (CI) 1.039-1.882, P = 0.027] and 1 year mortality (HR 1.327, 95% CI 1.020-1.728, P = 0.035) than the PaCO = 35-45 mmHg group. The PaCO > 45 mmHg group was associated with an increased risk of in-hospital mortality (HR 1.387, 95% CI 1.050-1.832, P = 0.021); the 1 year mortality showed no significant difference (HR 1.286, 95% CI 0.995-1.662, P = 0.055) compared with the PaCO = 35-45 mmHg group. The Kaplan-Meier survival curves showed that the PaCO < 35 mmHg group had a significantly lower 1 year survival rate. The area under the receiver operating characteristic curve for predicting in-hospital mortality was 0.591 (95% CI 0.526-0.656), and the 1 year mortality was 0.566 (95% CI 0.505-0.627) in the PaCO < 35 mmHg group.
In AHF patients, hypocapnia within 24 h after admission to the ICU was associated with increased in-hospital mortality and 1 year mortality. However, the increase in 1 year mortality may be influenced by hospitalization mortality. Hypercapnia was associated with increased in-hospital mortality.
在急性心力衰竭（AHF）患者中，高碳酸血症和低碳酸血症均很常见，但动脉血二氧化碳分压（PaCO）与 AHF 预后之间的关系仍不清楚。本研究旨在探讨 ICU 入院后 24 小时内 PaCO 与 AHF 患者住院期间和 1 年死亡率之间的关系。
从医疗信息集市重症监护 IV 数据库中招募了 AHF 患者。根据 PaCO 值将患者分为<35、35-45 和>45mmHg 三组。主要结局是研究 PaCO 与 AHF 患者住院期间死亡率和 1 年死亡率之间的关系。次要结局是评估 PaCO 预测 AHF 患者住院期间死亡率和 1 年死亡率的预测价值。本研究共纳入 2374 例患者，其中 PaCO<35mmHg 组 457 例，PaCO=35-45mmHg 组 1072 例，PaCO>45mmHg 组 845 例。住院死亡率为 19.5%，PaCO<35mmHg 组 1 年死亡率为 23.9%。多变量 logistic 回归分析显示，与 PaCO=35-45mmHg 组相比，PaCO<35mmHg 组住院死亡率（HR 1.398，95%CI 1.039-1.882，P=0.027）和 1 年死亡率（HR 1.327，95%CI 1.020-1.728，P=0.035）的风险增加。PaCO>45mmHg 组住院死亡率（HR 1.387，95%CI 1.050-1.832，P=0.021）的风险增加，而 1 年死亡率（HR 1.286，95%CI 0.995-1.662，P=0.055）与 PaCO=35-45mmHg 组相比无显著差异。Kaplan-Meier 生存曲线显示，PaCO<35mmHg 组 1 年生存率明显较低。PaCO<35mmHg 组预测住院死亡率的受试者工作特征曲线下面积为 0.591（95%CI 0.526-0.656），1 年死亡率为 0.566（95%CI 0.505-0.627）。
在 AHF 患者中，ICU 入院后 24 小时内的低碳酸血症与住院死亡率和 1 年死亡率增加有关。然而，1 年死亡率的增加可能受到住院死亡率的影响。高碳酸血症与住院死亡率增加有关。
