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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
Summary
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.
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