Home›Cardiology› Metabolic alkalosis shows no significant link to in-hospital mortality in acute heart failure
Metabolic alkalosis shows no significant link to in-hospital mortality in acute heart failureMeta-analysis shows no link between alkalosis and heart failure mortality
Revista clinica espanolaPublished November 1, 2026Study authors: Aguiló Oriol, Miró Òscar, Castells Xavi, Aronson Doron, Shirakabe Akihiro, Van Spall Harriette Gc, T…PubMed ↗DOI ↗Editorial oversight: Dr. Amelia Tan, PhD · Internal Medicine & Chronic Disease
AI-generated summary of the cited source, checked by automated accuracy review.
How we work
Share
Key Takeaway
Interpret alkalosis as an uncertain prognostic marker in acute heart failure; data are limited.
This meta-analysis assessed the association between alkalosis, including metabolic alkalosis (MA), and outcomes in patients with acute heart failure (AHF). The review included 5 studies, with a pooled sample of 19,296 patients for the meta-analysis. The primary outcome was in-hospital mortality; rehospitalisation was a secondary outcome.
For in-hospital mortality, the pooled odds ratio (OR) for alkalosis was 1.43 (95% CI 0.91-2.25), and for MA it was 1.47 (95% CI 0.95-2.27). Neither association was statistically significant. One prospective study reported an association with rehospitalisation at 30 and 90 days, but effect estimates were not reported.
The authors acknowledge that the limited available data do not allow robust conclusions to be drawn. The prognostic impact of MA in AHF therefore remains uncertain. No safety data were reported, and funding or conflicts of interest were not reported.
In practice, these findings do not support using alkalosis or MA as a reliable prognostic marker for in-hospital mortality in AHF. Clinicians should interpret the available evidence cautiously given the small number of studies and the wide confidence intervals.
How this fits prior evidence
This meta-analysis addresses a gap in prior coverage by evaluating alkalosis as a prognostic marker in acute heart failure, a topic not covered in previous items. Prior coverage has focused on mechanisms (mast cell activation), prediction models in diabetes, treatment options (heart transplantation, dapagliflozin), and rehabilitation barriers. Unlike those, this review examines a biochemical abnormality and its association with mortality, finding no significant link. The uncertainty aligns with the cautious framing of other prognostic and mechanistic findings previously covered.
Researchers looked at data from 19,296 patients with acute heart failure to see if metabolic alkalosis (MA) was linked to higher death rates. This review combined data from five different studies to check if this specific chemical imbalance in the blood affected survival for patients in the hospital.
The results showed no significant link between alkalosis and in-hospital mortality. While one study suggested a possible link to hospital readmission, the overall data was not strong enough to make a clear conclusion. Because the data was limited, the researchers could not say for certain how much this condition impacts patient outcomes.
Because the evidence is currently limited, the role of metabolic alkalosis in heart failure remains uncertain. Patients and doctors should view these findings as a starting point rather than a definitive rule. More research is needed to understand how this condition affects long-term care and hospital stays.
What this means for you:
Current data does not show a clear link between metabolic alkalosis and death in acute heart failure patients.
Common questions
Is metabolic alkalosis a sign of a worse outcome for heart failure patients?
The study of 19,296 patients found no significant association between alkalosis and in-hospital mortality. While one study mentioned a link to being readmitted to the hospital, the overall data is limited. Because of these limitations, the impact of metabolic alkalosis on heart failure patients remains uncertain.
How many people were included in this study?
The meta-analysis included data from 19,296 patients with acute heart failure. This large group was analyzed across five different studies to look for links between metabolic alkalosis and mortality or hospital readmission.
What are the risks of metabolic alkalosis in heart failure?
The study did not report specific safety concerns or adverse events related to metabolic alkalosis. However, because the available data is limited, researchers cannot yet draw robust conclusions about how this condition affects patient outcomes.
BACKGROUND AND OBJECTIVE: To assess the relationship between alkalosis or metabolic alkalosis (MA) and mortality or rehospitalisation in patients with acute heart failure (AHF) through a systematic review and meta-analysis.
MATERIALS AND METHODS: PubMed, Scopus and Web of Science were searched from inception to February 2025. Eligible studies included at least 50 patients and evaluated the association between alkalosis or MA and mortality or rehospitalisation in AHF. The review was conducted according to PRISMA guidelines and registered in PROSPERO (CRD42024525906).
RESULTS: Of 1,395 potentially relevant publications, five studies were included in the systematic review. The prevalence of alkalosis ranged from 12% to 44%, whereas the prevalence of MA ranged from 3% to 9%. Two retrospective studies found an association between MA and in-hospital mortality, although this finding was not confirmed in other studies. Only one prospective study reported an association between MA and rehospitalisation for AHF at 30 and 90 days of follow-up. Four studies including 19,296 patients were included in the meta-analysis. No significant association was observed between alkalosis or MA and in-hospital mortality (OR 1.43, 95% CI 0.91-2.25 and OR 1.47, 95% CI 0.95-2.27, respectively).
CONCLUSIONS: Very few studies have evaluated the relationship between alkalosis or MA and mortality or rehospitalisation in patients with AHF. The prognostic impact of MA in AHF remains uncertain. Meta-analysis showed no significant association between MA and in-hospital mortality. However, the limited available data do not allow robust conclusions to be drawn.
