Abstract
BackgroundAcid–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.ResultsOne 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 < 7.1 showed a 100% mortality rate. Acidosis attributable to lactate and unmeasured anions was independently associated with mortality in liver cirrhosis.ConclusionsCirrhosis and especially ACLF are associated with metabolic acidosis and acidemia owing to lactate and unmeasured anions. Acidosis and acidemia, respectively, are associated with increased 28-day mortality in liver cirrhosis. Lactate and unmeasured anions are main contributors to metabolic imbalance in cirrhosis and ACLF.
Highlights
Acid–base disturbances are frequently observed in critically ill patients at the intensive care unit
We demonstrate that critically ill patients with cirrhosis and acute-on-chronic liver failure (ACLF), respectively, differentiate considerably from patients without hepatic impairment in terms of acid–base balance
In conclusion, we could demonstrate that hyperchloremic acidosis and hypoalbuminemic alkalosis coexist in critically ill patients, including those with liver cirrhosis
Summary
Acid–base disturbances are frequently observed in critically ill patients at the intensive care unit. Derangements in acid–base balance are frequently observed in critically ill patients at the intensive care unit (ICU) and present in various patterns [1,2,3,4]. Acid–base status in critically ill patients with various disease entities has been extensively studied. While a balance of offsetting acidifying and alkalinizing metabolic acid–base disorders with a resulting equilibrated acid–base status has been described in stable cirrhosis [9], severe derangements with resulting net acidosis owing to hyperchloremic, dilutional and lactic acidosis were observed when cirrhosis was accompanied by critical illness [7, 8]. Acute liver failure (ALF) is characterized by a different acid–base pattern with dramatically increased lactate levels [10]. The acidifying effect of this increase in lactate was neutralized by hypoalbuminemia in non-paracetamol-induced ALF [11]
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