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Beyond the unmeasured anions: the clinics
Chiara Lazzeri
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Serafina Valente
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Gian Franco Gensini
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C. Lazzeri (&) S. Valente G. F. Gensini Intensive Cardiac Care Unit
, Florence,
Italy
Conflict of interest None.
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We thank Dr Berend for his kind suggestions. Beyond the
discussion and comparison between different types of
fruits, the aim of our investigation was to assess, on a
clinical ground, the prognostic values of base excess in
uncomplicated ST elevation myocardial infarction. Two
considerations arises from this. Firstly, despite the
universal controversy on the diagnostic power of different
methodological approaches for the evaluation of acidbase
disorders [1, 2] (diagnostic target), the assessment of
acidosis also retains a prognostic significance in different
clinical settings [35] (prognostic target). In this context,
recently, in acute myocardial infarction, anion gap (though
its diagnostic limits) proved to provide important
incremental information for initial risk stratification. In
agreement with these findings, and despite the scarcity of
data on acute cardiac patients on this topic, we documented
that the presence of low base excess was an independent
predictor for intra-ICCU complications (represented by
acute pulmonary edema and arrhythmias) in uncomplicated
ST elevation myocardial infarction submitted to
percutaneous interventions. Secondly, the available literature
dealing with the diagnostic significance of acidbase
parameters stems mainly from studies in critically ill
patients. A recent growing body of evidence [35] strongly
supports the notion that HCO3, base excess and anion gap
(corrected for hypoalbuminemia, when needed) remain the
most appropriate for clinical usage. In our investigation we
enrolled consecutive uncomplicated STEMI patients,
mirroring the real world scenario. These patients do not show
hypoalbuminemia and hence anion gap correction is not
necessary. In our opinion, the strength of our investigation
is represented by the fact that easily available parameters
(such as base excess) proved to help clinicians in
optimizing risk stratification in the early phase of STEMI
patients, even if uncomplicated. Like Dr Berend, we agree
that Cl/Na deserves further studies in a larger cohort of
patients in order to better clarify its clinical significance
since it is a very feasible parameter, and that is what we
have expressed in the section limit of the study.
We are very grateful for the suggestions and challenges
posed by Dr Berend. Yet we are convinced that in the
dialectic reasoning on acidbase evaluation, the clinical
significance of parameters should also be taken into
account, bearing in mind the recent evidence.
(...truncated)