Renal replacement therapy in critically ill liver cirrhotic patients—outcome and clinical implications

Staufer, Katharina; Roedl, Kevin; Kivaranovic, Danijel; Drolz, Andreas; Horvatits, Thomas; Rasoul‐Rockenschaub, Susanne; Zauner, Christian; Trauner, Michael; Fuhrmann, Valentin

doi:10.1111/liv.13389

Cited by 58 publications

(68 citation statements)

References 28 publications

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“…), laboratory and radiological findings (typical morphological changes of the liver, sings of portal hypertension, etc. in ultrasonography or computed tomography scanning), or via histology, if available …”

Section: Methodsmentioning

confidence: 99%

Lactate Improves Prediction of Short‐Term Mortality in Critically Ill Patients With Cirrhosis

et al. 2019

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Section: Methodsmentioning

confidence: 99%

Lactate Improves Prediction of Short‐Term Mortality in Critically Ill Patients With Cirrhosis

et al. 2019

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“…Moreover, the clinical course of patients admitted to the hospital seems to be important for the prognosis, especially because development of ACLF presents a major crossroad in the clinical evolution and therefore management of the patients . In critically ill patients with cirrhosis, diagnosis of ACLF could play an important role in the timing of several therapeutic decisions, such as renal replacement therapy, plasma exchange, artificial liver support, and liver transplantation . Therefore, early diagnosis of patients with AD, who will develop ACLF after admission to the intensive care unit (ICU), is crucial …”

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confidence: 99%

Fibroblast growth factor 21 is an early predictor of acute‐on‐chronic liver failure in critically ill patients with cirrhosis

Ruiz-Margáin

Pohlmann²,

Ryan³

et al. 2018

Liver Transpl

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Acute-on-chronic liver failure (ACLF) develops in acute decompensation (AD) of cirrhosis and shows high mortality. In critically ill patients, early diagnosis of ACLF could be important for therapeutic decisions (eg, renal replacement, artificial liver support, liver transplantation). This study evaluated fibroblast growth factor 21 (FGF21) as a marker of mitochondrial dysfunction in the context of ACLF. The study included 154 individuals (112 critically patients and 42 healthy controls) divided into a training and a validation cohort. In the training cohort of 42 healthy controls and 34 critically ill patients (of whom 24 were patients with cirrhosis), levels of FGF21, interleukin (IL) 6, and IL8 were measured. In the validation cohort of 78 patients with cirrhosis, 17 patients were admitted with or developed ACLF during follow-up and underwent daily clinical and nutritional assessment. Levels of FGF21 were higher in critically ill patients, especially in patients with cirrhosis admitted to the intensive care unit (ICU). Moreover, FGF21 as well as IL6 and IL8 levels were higher in patients with ACLF, but they did not increase with the severity of ACLF. Interestingly, in the validation cohort, FGF21 was also elevated in the patients who developed ACLF in the next 7 days. In these patients, FGF21 levels were an independent predictor of ACLF presence and development in multivariate analysis together with Child-Pugh score. FGF21 levels had no impact on the survival of critically ill patients with cirrhosis. In conclusion, this study demonstrates that FGF21 levels are of specific diagnostic value regarding the presence and development of ACLF in patients admitted to ICU for AD of liver cirrhosis. Further studies are warranted to address pathophysiological and possible therapeutic implications. Liver Transplantation 24 595-605 2018 AASLD.

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“…Acute kidney injury (AKI) is a common complication in patients with severe liver disease, and the requirement for continuous renal replacement therapy (CRRT) in these individuals is associated with a particularly high mortality [1]. The optimal intensity of CRRT in critically ill patients with both AKI and liver dysfunction is uncertain [2,3].…”

Section: Introductionmentioning

confidence: 99%

Higher versus Lower Continuous Renal Replacement Therapy Intensity in Critically ill Patients with Liver Dysfunction

et al. 2017

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Aims: To study the association between higher versus lower continuous renal replacement therapy (CRRT) intensity and mortality in critically ill patients with combined acute kidney injury and liver dysfunction. Methods: Post-hoc analysis of patients with liver dysfunction (Sequential Organ Failure Assessment liver score ≥2 or diagnosis of liver failure/transplant) included in the Randomized Evaluation of Normal versus Augmented Level renal replacement therapy (RENAL) trial. Results: Of 444 patients, 210 (47.3%) were randomized to higher intensity (effluent flow 40 mL/kg/h) and 234 (52.7%) to lower intensity (effluent flow 25 mL/kg/h) therapy. Overall, 79 and 86% of prescribed effluent flow was delivered in the higher-intensity and lower-intensity groups, respectively (p < 0.001). In total, 113 (54.1%) and 120 (51.3%) patients died in each group. On multivariable Cox regression analysis, we found no independent association between higher CRRT intensity and mortality (HR 0.93, 95% CI 0.70-1.24; p = 0.642). Conclusions: In RENAL patients with liver dysfunction, higher CRRT intensity was not associated with reduced mortality.

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Renal replacement therapy in critically ill liver cirrhotic patients—outcome and clinical implications

Abstract: Mortality in critically ill cirrhotics with need for RRT is substantially high independent of LT options. Only a small proportion showed renal recovery after ICU discharge. CLIF-C ACLF and CLIF-SOFA score may assist in identifying patients who would not benefit from RRT.

Cited by 58 publications

References 28 publications

Lactate Improves Prediction of Short‐Term Mortality in Critically Ill Patients With Cirrhosis

Lactate Improves Prediction of Short‐Term Mortality in Critically Ill Patients With Cirrhosis

Fibroblast growth factor 21 is an early predictor of acute‐on‐chronic liver failure in critically ill patients with cirrhosis

Higher versus Lower Continuous Renal Replacement Therapy Intensity in Critically ill Patients with Liver Dysfunction

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