Admission Serum Bicarbonate Predicts Adverse Clinical Outcomes in Hospitalized Cirrhotic Patients.

Adam Tepler,Anand Kumar,Michael Schopis,Michael Parides,Paulo L Bittencourt,Samuel Sigal

doi:10.1155/2021/9915055

Adam Tepler, Anand Kumar + Show 4 more

Open Access

https://doi.org/10.1155/2021/9915055

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Abstract

A low serum bicarbonate (SB) level is predictive of adverse outcomes in kidney injury, infection, and aging. Because the liver plays an important role in acid-base homeostasis and lactic acid metabolism, we speculated that such a relationship would exist for patients with cirrhosis. To assess the prognostic value of admission SB on adverse hospital outcomes, clinical characteristics were extracted and analyzed from a large electronic health record system. Patients were categorized based on admission SB (mEq/L) into 7 groups based on the reference range (22–25) into mildly (18–21), moderately (14–17), and severely (<14) decreased groups and mildly (26–29), moderately (30–33), and severely (>30) increased groups, and the relationship of SB category with the frequency of complications (acute kidney injury/hepatorenal syndrome, portosystemic encephalopathy, gastrointestinal bleeding, ascites, and spontaneous bacterial peritonitis) and hospital metrics (length of stay [LOS], admission to an intensive care unit [ICU], and mortality) was assessed. A total of 2,693 patients were analyzed. Mean SB was 22.9 ± 4.5 mEq/L. SB was within the normal range (22–25 mEq/L) in 1,072 (39.8%) patients, and 955 patients (36%) had a low SB. As the SB category decreased, the incidence of complications progressively increased (p < 0.001). Increased MELD-Na score and low serum albumin also correlated with frequency of complications (p < 0.001). As the SB category decreased, LOS, ICU admission, and mortality progressively increased (p < 0.001). On multivariate analysis, the association of decreased SB with higher odds of complications, LOS, ICU admission, and mortality persisted. Conclusion. Low admission SB in patients with cirrhosis is associated with cirrhotic complications, longer LOS, increased ICU admissions, and increased hospital mortality.

Highlights

Acid-base disturbances are common in patients with cirrhosis
In this study we report that admission serum bicarbonate (SB) was an important prognostic marker for adverse hospital outcomes for the cirrhotic patient
Low admission SB was significantly associated with an increased risk of a discharge diagnosis of renal failure, PSE, GIB, and SBP

Summary

Introduction

Acid-base disturbances are common in patients with cirrhosis. In early stages of cirrhosis, acidosis results from dilutional hypervolemia and hyperchloremia, whereas alkalosis occurs due to hypoalbuminemia and respiratory alkalosis [1]. As the severity of cirrhosis progresses, patients often develop a net metabolic acidosis, especially in those with acute and chronic liver failure with sepsis in which increased levels of lactic acid and unmeasured anions accumulate [1, 3, 4]. Acid-base imbalances with decreased SB levels are common in patients with chronic kidney disease (CKD), acute kidney injury (AKI), and infection, and the elderly. In AKI and CKD low SB is associated with increased severity of illness and is predictive of adverse hospital outcomes and mortality [5, 6]. Based on the significance of acidosis in cirrhosis and low SB in other chronic disease states, we speculated that SB would be predictive of adverse hospital outcomes for the hospitalized cirrhotic patient

Materials and Methods

Results

Relationship of Admission SB Category and Adverse Hospital Metrics

Discussion