Background: Influence of admission levels of arterial carbon dioxide (CO2) levels, which may be suggestive of severe disease state, on clinical outcomes in patients with acute decompensated heart failure (ADHF) are not well-established. We hypothesized that low admission levels of partial pressure of arterial carbon dioxide (PaCO2) possibly due to severe pulmonary congestion is associated with worse clinical outcomes in patients with ADHF. Methods: We studied eligible ADHF patients admitted to the cardiac intensive-care unit from 2007–2011. All patients were categorized into 3 groups according to the tertiles of admission PaCO2. Association between admission PaCO2 and long-term mortality was assessed by multivariable Cox proportional regression. Results: Among 435 eligible patients, 26.4% died at a median follow-up of 1.8 years. In the multivariable analysis including tertiles of PaCO2 and other baseline variables (age, sex, body mass index, ischemic etiology, atrial fibrillation, heart rate, B-type natriuretic peptide, hemoglobin, C-reactive protein, sodium and potassium levels), patients in the lowest tertile (PaCO2 <31.7 Torr) showed a greater risk of mortality (hazard ratio (HR), 2.18; P = .025) whereas those in the highest tertile (PaCO2 >36.8 Torr) did not (HR, 1.22; P = .587) compared with those in the middle tertile (PaCO2 ranged from 31.7 to 36.8 Torr). Conclusion: In patients with ADHF, the lower the PaCO2 level on admission, the greater the risk of long-term mortality.
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