Gur Ivan, Gutgold Amichai, Milo Gai, Miller Asaf
Department of Internal Medicine C, Rambam Health Care Campus, Haifa 3109601, Israel.
Medical Intensive Care Unit, Rambam Health Care Campus, Haifa 3109601, Israel.
J Clin Med. 2024 Oct 12;13(20):6077. doi: 10.3390/jcm13206077.
The prognostic significance of alkalemia found in an initial emergency department (ED) evaluation has not been described thus far. We retrospectively reviewed the records of all patients aged 18 years or older evaluated in the ED of one large academic referral center during 2000-2023. Included patients were those with at least one measurement of pH ≥ 7.55 upon initial ED presentation. Alkalemia was deemed primarily metabolic (PM) if PCO was ≥35 mmHg and primarily respiratory (PR) if bicarbonate levels were ≤24 mEq/L. The primary outcome was survival 30 days from ED presentation. Of 2440 patients included, 199 (8.1%) had PM and 1494 (61.2%) had PR. Alkalemia severity was not correlated with prognosis. Survival at 30 days was significantly ( < 0.001) lower in the PM group (78.9%) compared with that of either the PR (95.3%) or the combined etiology (92.2%) groups. Multivariate survival analysis after balancing potential observed confounders using propensity score matching revealed the type of alkalemia (PM vs. PR) to be a significant predictor of 30-day mortality (aHR 1.73; 95% C.I. = [1.07 to 2.82]; = 0.026), irrespective of age, other laboratory values obtained on ED evaluation (including pH), past medical history, or vital signs on presentation. In patients presenting to the ED with significant alkalemia, the mechanism of alkalemia, i.e., primarily metabolic versus primarily respiratory, rather than the absolute degree of alkalemia, is associated with increased mortality.
目前尚未描述在急诊科（ED）初始评估中发现的碱血症的预后意义。我们回顾性分析了2000年至2023年期间在一家大型学术转诊中心急诊科接受评估的所有18岁及以上患者的记录。纳入的患者是那些在急诊科初次就诊时至少有一次pH值测量≥7.55的患者。如果PCO≥35 mmHg，则碱血症被认为主要是代谢性的（PM）；如果碳酸氢盐水平≤24 mEq/L，则碱血症被认为主要是呼吸性的（PR）。主要结局是从急诊科就诊起30天的生存率。在纳入的2440例患者中，199例（8.1%）有PM，1494例（61.2%）有PR。碱血症严重程度与预后无关。与PR组（95.3%）或混合病因组（92.2%）相比，PM组30天生存率显著降低（<0.001）（78.9%）。使用倾向评分匹配平衡潜在观察到的混杂因素后的多变量生存分析显示，碱血症类型（PM与PR）是30天死亡率的显著预测因素（aHR 1.73；95%置信区间=[1.07至2.82]；P=0.026），与年龄、急诊科评估时获得的其他实验室值（包括pH值）、既往病史或就诊时的生命体征无关。在出现严重碱血症的急诊科患者中，碱血症的机制，即主要是代谢性还是主要是呼吸性，而非碱血症的绝对程度，与死亡率增加相关。
