Metabolic acidosis in critically ill patients with cirrhosis: Epidemiology and short-term mortality risk factors

Gao, Feng; Lin, Miao-Tong; Yang, Xiaoling; Cai, Mengxing; Hao, Nan; Xie, Wei; Huang, Zhiming

doi:10.5152/tjg.2019.18813

Cited by 9 publications

(8 citation statements)

References 28 publications

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“…Therefore, identifying cirrhotic patients with AKI who are at high risk of mortality is very important and may be helpful for providing timely medical interventions to improve the prognosis of these patients. Currently, many studies have investigated risk factors for mortality in patients with cirrhosis[ 10 ] and other complications, such as gastroesophageal variceal bleeding[ 11 , 12 ], ascites[ 13 ], bacterial infections[ 14 ] and metabolic acidosis[ 15 ]. Moreover, a number of studies have focused on identifying the risk factors for the development of AKI in patients with cirrhosis[ 16 - 19 ] and other conditions[ 20 - 22 ].…”

Section: Introductionmentioning

confidence: 99%

Development and validation of a nomogram for predicting overall survival in cirrhotic patients with acute kidney injury

Wan¹,

Wang²,

Zhang³

et al. 2022

WJG

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BACKGROUND Acute kidney injury (AKI) is a common and severe complication in patients with cirrhosis, and is associated with poor prognosis. Therefore, identifying cirrhotic patients with AKI who are at high risk of mortality is very important and may be helpful for providing timely medical interventions to improve the prognosis of these patients. However, studies focused on investigating the risk factors for the mortality of cirrhotic patients with AKI were scarce. AIM To identify risk factors for mortality and establish a nomogram for predicting the prognosis of these patients. METHODS Two hundred fifty consecutive patients with cirrhosis and AKI were recruited and randomly divided into training cohort ( n = 173) and validation cohort ( n = 77). In the training cohort, potential risk factors for death were identified by performing a Cox regression analysis, and a nomogram was established. The predictive performance of the nomogram was internally and externally validated by calculating the area under the receiver operating characteristic curve (AUROC), constructing a calibration curve and performing decision curve analysis. RESULTS The serum sodium level, international normalized ratio, peak serum creatinine level > 1.5 mg/dL, the presence of hepatic encephalopathy and diabetes were potential risk factors for mortality of cirrhotic patients with AKI in the training dataset. A prognostic nomogram incorporating these variables was established for predicting the overall survival of these patients. Compared with Child-Turcotte-Pugh, the model for end-stage liver disease (MELD) and the MELD-Na scores, the nomogram in predicting 90- and 180-d mortality exhibited better discriminatory power with AUROCs of 0.792 and 0.801 for the training dataset and 0.817 and 0.862 for the validation dataset, respectively. With a nomogram score of 98, patients were divided into low- and high-risk groups, and high-risk patients had a higher mortality rate. CONCLUSION A prognostic nomogram displayed good performance for predicting the overall survival of cirrhotic patients with AKI, and will assist clinicians in evaluating the prognosis of these patients.

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Section: Introductionmentioning

confidence: 99%

Development and validation of a nomogram for predicting overall survival in cirrhotic patients with acute kidney injury

Wan¹,

Wang²,

Zhang³

et al. 2022

WJG

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“…Several studies showed that acidosis was positively associated with mortality in critically ill patients. For example, a study conducted by Gao et al [ 19 ] reported that cirrhosis patients of metabolic acidosis had a high mortality rate and lactic acidosis was the worst prognosis of all types of metabolic acidosis. Another observational study showed that metabolic acidosis was closely associated with adverse kidney outcomes and mortality in patients with non-dialysis dependent chronic kidney disease [ 20 ].…”

Section: Discussionmentioning

confidence: 99%

Prognostic value of serum lactate level for mortality in patients with acute kidney injury

Chen,

2024

Eur J Med Res

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Background Serum lactate is associated with mortality in diverse kinds of patients. This study aimed to investigate whether serum lactate level may independently predict mortality in acute kidney injury (AKI) patients. Methods A total of 4461 AKI patients were collected from the Medical Information Mart for Intensive Care (MIMIC III) database and followed up for 365 days. According to serum lactate tertiles, participants were divided into three groups (Q1–Q3) by: Q1 ≤ 1.60 mg/dl, Q2 = 1.61–2.70 mg/dl, and Q3 ≥ 2.71 mg/dl. We calculated the hazard ratio (HR) and 95% confidence intervals (Cls) for mortality across each tertile of lactate by using the Q1 as reference and constructed four models to adjust for the HR of mortality. Results Nonsurvivors had significantly higher lactate compared with patients in the survival group. Mortality rate gradually elevated with the increase in serum lactate level (Q1: 29.30%, Q2: 33.40%, Q3: 37.40%). When compared with Q1 after adjustment of all confounders, the HRs of Q3 still was 1.20 (95% Cl 1.05–1.37). Conclusions This study demonstrated that high serum lactate levels were an independent predictor of mortality in AKI patients.

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“…At the same time, the acid-base imbalance in the body needs to be corrected, to reduce the mortality of patients. [26] At present, in the development of scoring tools, clinical prediction rules (CPRs) are common methods. CPRs are often referred to as predictive models or risk scores.…”

Section: Discussionmentioning

confidence: 99%

Construction of a nomogram predictive model for patients with liver rupture undergoing surgical intervention

Zhu¹

2023

Ulus Travma Acil Cerrahi Derg

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BACKGROUND:The incidence of blunt abdominal injury has significantly increased, and the liver is one of the most commonly damaged organs. In this study, we explored and established a nomogram model for patients with liver ruptures undergoing surgical treatment. METHODS:A retrospective analysis was conducted for 66 adult patients with liver rupture, who were admitted to our hospital from January 2011 to October 2018. These patients were classified into two groups, according to whether the patient had surgery: surgery group (41 cases) and non-surgical group (25 cases). The following data were collected from these two groups of patients: gender, age, injury mechanism, liver damage, laboratory test results, and hospitalization. Multivariate logistic regression analysis was performed to screen the risk factors of patients who require surgical treatment, establish a predictive model based on the selected indicators, and draw the nomogram. Receiver operating characteristic curves and the calibration curve were used to evaluate the predictive value of the model. RESULTS:Compared to the non-surgical group, the body temperature decreased, the heart rate increased, the injury severity score grade increased, the blood urea nitrogen, blood uric acid, creatinine (Cr), arterial partial pressure of oxygen, alkali excess, blood lactic acid and creatine kinase isoenzymes MB (CK-MB) increased, and the HCO-and Glasgow Coma Scale (GCS) coma scores decreased for patients in the surgical group (all, p<0.05). The logistic regression analysis revealed that Cr, arterial partial pressure of oxygen, HCO3-, CK-MB, and the Glasgow coma score were the influencing factors for surgical intervention for liver rupture. The nomogram model constructed based on these five indicators had a good degree of discrimination (area under the curve = 0.971, 95% CI: 0.896-0.997) and accuracy.CONCLUSION: A nomogram model established based on Cr, arterial partial pressure of oxygen, HCO3-, CK-MB, the GCS, and other parameters can accurately predict the surgical treatment of patients with liver rupture.

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Metabolic acidosis in critically ill patients with cirrhosis: Epidemiology and short-term mortality risk factors

Cited by 9 publications

References 28 publications

Development and validation of a nomogram for predicting overall survival in cirrhotic patients with acute kidney injury

Development and validation of a nomogram for predicting overall survival in cirrhotic patients with acute kidney injury

Prognostic value of serum lactate level for mortality in patients with acute kidney injury

Construction of a nomogram predictive model for patients with liver rupture undergoing surgical intervention

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