Acid–base status and its clinical implications in critically ill patients with cirrhosis, acute-on-chronic liver failure and without liver disease

Background Acid–base disturbances are frequently observed in critically ill patients at the intensive care unit. To our knowledge, the acid–base profile of patients with acute-on-chronic liver failure (ACLF) has not been evaluated and compared to critically ill patients without acute or chronic live...

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Published in:Annals of intensive care 2018-04, Vol.8 (1), p.48-12, Article 48
Main Authors: Drolz, Andreas, Horvatits, Thomas, Roedl, Kevin, Rutter, Karoline, Brunner, Richard, Zauner, Christian, Schellongowski, Peter, Heinz, Gottfried, Funk, Georg-Christian, Trauner, Michael, Schneeweiss, Bruno, Fuhrmann, Valentin
Format: Article
Language:English
Subjects:
Acidosis
Acid–base
Acute-on-chronic liver failure
Anesthesiology
Cirrhosis
Critical Care Medicine
Emergency Medicine
Intensive
Intensive care
Liver cirrhosis
Liver diseases
Medicine
Medicine & Public Health
Metabolism
Mortality
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Summary:Background Acid–base disturbances are frequently observed in critically ill patients at the intensive care unit. To our knowledge, the acid–base profile of patients with acute-on-chronic liver failure (ACLF) has not been evaluated and compared to critically ill patients without acute or chronic liver disease. Results One hundred and seventy-eight critically ill patients with liver cirrhosis were compared to 178 matched controls in this post hoc analysis of prospectively collected data. Patients with and without liver cirrhosis showed hyperchloremic acidosis and coexisting hypoalbuminemic alkalosis. Cirrhotic patients, especially those with ACLF, showed a marked net metabolic acidosis owing to increased lactate and unmeasured anions. This metabolic acidosis was partly antagonized by associated respiratory alkalosis, yet with progression to ACLF resulted in acidemia, which was present in 62% of patients with ACLF grade III compared to 19% in cirrhosis patients without ACLF. Acidemia and metabolic acidosis were associated with 28-day mortality in cirrhosis. Patients with pH values
ISSN:2110-5820
2110-5820
DOI:10.1186/s13613-018-0391-9