Metabolic alkalosis and clinical outcomes in acute heart failure: a systematic review and meta-analysis.
Oriol Aguiló, Òscar Miró, Xavi Castells et al.
✦ AI-curated · Sources linked
In 30 seconds
This systematic review and meta-analysis examined whether alkalosis or metabolic alkalosis (MA) is associated with mortality or rehospitalisation among patients with acute heart failure. Five studies met the review criteria, and four studies including 19,296 patients contributed to the meta-analysis. Neither alkalosis nor MA was significantly associated with in-hospital mortality: the respective odds ratios were 1.43 (95% CI 0.91-2.25) and 1.47 (95% CI 0.95-2.27). Findings across individual studies were inconsistent, and the prognostic significance of MA remains uncertain.
Key findings
- Alkalosis prevalence ranged from 12% to 44%, while metabolic alkalosis prevalence ranged from 3% to 9%.
- Meta-analysis found no significant association with in-hospital mortality for alkalosis (OR 1.43, 95% CI 0.91-2.25) or metabolic alkalosis (OR 1.47, 95% CI 0.95-2.27).
- Two retrospective studies linked metabolic alkalosis with in-hospital mortality, but other studies did not confirm the finding.
- Only one prospective study reported an association between metabolic alkalosis and acute heart failure rehospitalisation at 30 and 90 days.
Why it matters
Acid–base abnormalities may be considered when assessing risk in acute heart failure, but this review does not establish metabolic alkalosis as a reliable prognostic marker. The inconsistent study findings and absence of a significant pooled association with in-hospital mortality underscore the uncertainty clinicians should bear in mind when interpreting alkalosis in this setting.
What to keep in mind
Only five studies were included, and just four contributed to the meta-analysis. The limited and inconsistent evidence, including sparse rehospitalisation data, prevents robust conclusions.