Journal of Clinical and Translational Hepatology

Journal of Clinical and Translational Hepatology

Saturday, 11 / 16 / 2019

Articles

Metabolic Acidosis in Critically Ill Cirrhotic Patients with Acute Kidney Injury

ORIGINAL ARTICLE

Metabolic Acidosis in Critically Ill Cirrhotic Patients with Acute Kidney Injury

Dan-Qin Sun#,1,2, Lai Zhang#,1, Chen-Fei Zheng3, Wen-Yue Liu4, Kenneth I. Zheng5, Xiao-Ming Chen6, Ming-Hua Zheng*,5,7,8 and Wei-Jie Yuan*,2

1Department of Nephrology, The Affiliated Wuxi No. 2 People’s Hospital of Nanjing Medical University, Wuxi, China
2Department of Nephrology, Shanghai General Hospital of Nanjing Medical University, Shanghai, China
3Department of Nephrology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
4Department of Endocrinology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
5NAFLD Research Center, Department of Hepatology, the First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
6Zhejiang Engineering Research Center of Intelligent Medicine, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
7Institute of Hepatology, Wenzhou Medical University, Wenzhou, China
8Key Laboratory of Diagnosis and Treatment of Severe Hepato-Pancreatic Diseases of Zhejiang Province, Wenzhou, China
#These authors contributed equally to this work.
*Correspondence to: Wei-Jie Yuan, Department of Nephrology, Shanghai General Hospital, Nanjing Medical University, Shanghai 200080, China. E-mail: This email address is being protected from spambots. You need JavaScript enabled to view it. ; Ming-Hua Zheng, Department of Hepatology, NAFLD Research Center, The First Affiliated Hospital of Wenzhou Medical University; No. 2 Fuxue Lane, Wenzhou 325000, China. E-mail: This email address is being protected from spambots. You need JavaScript enabled to view it.

Journal of Clinical and Translational Hepatology 2019;7(2):112-121 DOI: 10.14218/JCTH.2019.00013
Received: March 22, 2019 Accepted: April 22, 2019 Published online: May 20, 2019

Abstract

Background and Aims: The metabolic acid-base disorders have a high incidence of acute kidney injury (AKI) in critically ill cirrhotic patients (CICPs). The aims of our study were to ascertain the composition of metabolic acidosis of CICPs with AKI and explore its relationship with hospital mortality.

Methods: Three-hundred and eighty consecutive CICPs with AKI were eligible for the cohort study. Demographic, clinical and laboratory parameters were recorded and arterial acid-base state was analyzed by the Stewart and Gilfix methodology.

Results: Net metabolic acidosis, lactic acidosis, acidosis owing to unmeasured anions, acidemia, and dilutional acidosis were less frequent in the non-survival group compared to the survival group of CICPs. The presence of acidemia, acidosis owing to unmeasured anions, and lactic acidosis were independently associated with increased risk of intensive care unit 30-day mortality, with hazard ratios of 2.11 (95% confidence interval (CI): 1.43–3.12), 3.38 (95% CI: 2.36–4.84), and 2.16 (95% CI: 1.47–3.35), respectively. After full adjustment for confounders, the relationship between acidosis owing to unmeasured anions with hospital mortality was still significant, with hazard ratio of 2.29 (95% CI: 1.22–4.30). Furthermore, arterial lactate concentration in combination with chronic liver failure-sequential organ failure assessment and BEUMA had the strongest ability to differentiate 30-day mortality (area under the receiver operating characteristic curve: 0.79, 95% CI: 0.74–0.83).

Conclusions: CICPs with AKI exhibit a complex metabolic acidosis during intensive care unit admission. Lactic acidosis and BEUMA, novel markers of acid-base disorders, show promise in predicting mortality rate of CICPs with AKI.

Keywords

Metabolic acidosis, Critically ill cirrhotic patients, Acute kidney injury, Hospital morality

 

 

 

 

Journal of Clinical and Translational Hepatology 2019 vol. 7, 112-121  [ Html ] [ PDF Full-text ]

 

© The Authors 2018. This article is published under the terms of the Creative Commons Attribution-Noncommercial License (CC BY-NC 4.0), which permits use, distribution, and reproduction in any medium, provided the original work is properly cited, the use is non commercial and is otherwise in compliance with the license.

 

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