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Is Preoperative Serum Bicarbonate an Undervalued Risk Factor in Cardiac Surgery?

Wesley Chorney1, John Hinchion2

  • 1College of Medicine and Health, University College Cork, College Road, Cork, T12K8AF, County Cork, Ireland. wchorney@umail.ucc.ie.

Journal of Cardiovascular Translational Research
|July 13, 2026
PubMed

Insights

Pre-operative bicarbonate levels are a significant predictor of 30-day mortality in cardiothoracic surgery patients. Lower bicarbonate levels, especially below 20 mmol/L, indicate higher risk, suggesting its use in risk stratification.

Area of Science:

  • Cardiology
  • Nephrology
  • Critical Care Medicine

Background:

  • Current risk stratification in cardiothoracic surgery lacks pre-operative bicarbonate level assessment.
  • Bicarbonate levels are crucial indicators of acid-base balance and renal function.

Purpose of the Study:

  • To evaluate the predictive value of pre-operative bicarbonate levels for 30-day mortality in cardiothoracic surgery.
  • To compare bicarbonate's predictive power against demographic, hematologic, and renal function indicators.

Main Methods:

  • Utilized the MIMIC-IV database to identify 11,261 patients undergoing cardiac procedures.
  • Modeled 30-day mortality using pre-operative bicarbonate levels and other clinical indicators.

Main Results:

  • Minimum pre-operative bicarbonate level was identified as an independent risk factor for 30-day mortality.
  • Patients in the lowest bicarbonate quartile (<20 mmol/L) exhibited significantly increased mortality.

Conclusions:

  • Pre-operative bicarbonate levels offer valuable predictive information for post-operative mortality.
  • Incorporating bicarbonate levels into risk stratification models can enhance patient outcome prediction in cardiothoracic surgery.

Keywords:
BicarbonateCardiothoracic surgeryMortalityRegression modeling

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