Admission Serum Bicarbonate Predicts Adverse Clinical Outcomes in Hospitalized Cirrhotic Patients

Schopis, Michael; Kumar, Anand; Parides, Michael K.; Tepler, Adam; Sigal, Samuel H.

doi:10.1155/2021/9915055

Cited by 4 publications

(2 citation statements)

References 38 publications

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“…However, while many studies of LC have focused on patients in the ICU, [10][11][12] according to 1 study they comprise only 8.7% of those hospitalized with LC. [13] Furthermore, the studies of patients with LC visiting the ED have focused either on those with sepsis or other complications, or included a small number of patients, or those with LC from all causes. [5,6,[14][15][16][17][18][19][20] With the rate of alcoholic LC in South Korea increasing and no change in the number of Korean patients with decompensated LC, a study of the predictive factors for those patients who visited the ED is warranted.…”

Section: Introductionmentioning

confidence: 99%

Factors predicting mortality in patients with alcoholic liver cirrhosis visiting the emergency department

et al. 2023

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Liver cirrhosis (LC) is a major cause of morbidity and mortality worldwide and is becoming a regional and healthcare burden. South Korea is one of the 10 countries with the highest age standardized prevalence of decompensated LC. Moreover, the proportion of patients with alcoholic LC is increasing and there has been no decrease in the incidence of decompensated alcoholic LC. Patients with decompensated LC frequently visit the emergency department (ED). Several studies focused on patients with LC who visited the ED, but the studies about alcoholic LC were limited. This study aimed to identify predicting factors for mortality in alcoholic LC patients visiting the ED. This was a retrospective study of alcoholic LC patients who visited an ED between November 2017 and June 2021. The baseline characteristics, complications of LC, model for end-stage liver disease (MELD) score, and laboratory values including lactate were assessed. The primary outcome was in-hospital mortality. In total, 433 patients with alcoholic LC were included for analysis and the in hospital mortality rate was 15.9% (n = 69). Univariate regression analyses identified that MELD score, lactate, platelet, international normalized ratio, bilirubin, creatinine, albumin, and C-reactive protein (CRP) predicted in-hospital mortality. Multivariate regression analysis showed that MELD score, lactate, albumin, and CRP were significantly associated with in-hospital mortality. MELD score, lactate, albumin, and CRP predicted the mortality in alcoholic LC patients visiting the ED.

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Section: Introductionmentioning

confidence: 99%

Factors predicting mortality in patients with alcoholic liver cirrhosis visiting the emergency department

et al. 2023

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“…Patients with liver dysfunction often develop multiple complex co-existing metabolic acid-base disorders as the severity of cirrhosis progresses. (1) The most prevalent type of acidosis in intensive care unit (ICU) patients with cirrhosis is lactic acidosis. In decompensated cirrhotic patients, hypoalbuminemia alkalosis is the primary alkalinizing metabolic disorder.…”

Section: Introductionmentioning

confidence: 99%

Impact of Serum levels of Bicarbonate and Electrolytes on Adverse Clinical Outcomes in Cirrhotics

Abdelaal,

Abd El-rahman,

abo-dahab

et al. 2023

Sohag Medical Journal

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Background: It is well known that acid-base imbalances and low serum bicarbonate are linked to increased illness severity. Aim: To examine the prognostic significance of information obtained from arterial blood gas (ABG)-related parameters and serum electrolytes at the time of hospital admission on adverse clinical outcomes, the length of LOS, and other factors. Methods: A total of 357 candidate individuals with liver cirrhosis were screened for enrollment in this prospective study. 329 patients agreed to participate who had evidence of liver cirrhosis or presented with signs and symptoms suggesting decompensated liver cirrhosis. Individuals with diabetes ketoacidosis, acute coronary syndrome, fulminant liver failure, preexisting end-stage renal disease, or chronic obstructive pulmonary disease (a total of 208) weren't involved in the research. Then, 121 patients who were hospitalized in the Internal Medicine department or treated in ICU with a confirmed diagnosis of decompensated cirrhosis (age ≥ 18 years) were prospectively recruited and monitored throughout the research period. Results: This research involved 121 cases with a confirmed diagnosis of cirrhosis. Regarding the PH, normal PH were 76 (62.8%) patients, acidemia 22 (18.2%), alkalemia 23 (18.2). There were 73 (60.4%) patients were child C score at time of admission. The mean MELD score was 19.26± 9.01. The mean MELD-PaCO2-HCO3 was 23.79 ± 7.45 while the mean MELD-bicarbonate was 16.35±7.22. As a regimen of management, serum electrolyte acid base correction was used in 33 (27.3%) cases, while endoscopy or band ligation was performed in 40 (33.1%) cases. Medication for Na and K correction were used in 6 (5%) and 17 (14%) cases respectively. Vasopressors were used in 12 (9.9%) cases who were admitted to the ICU. None of the cases underwent renal replacement therapy. Conclusion:The high incidence of metabolic acidosis and the frequency of organ failures are strong predictors of death in critically ill individuals with cirrhosis, leading to a poor prognosis and a high mortality rate.

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Identification of key predictors of hospital mortality in critically ill patients with embolic stroke using machine learning

Liu

Bai

et al. 2022

Bioscience Reports

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Embolic stroke (ES) is characterized by high morbidity and mortality. Its mortality predictors remain unclear. This study aimed to use machine learning (ML) to identify the key predictors of mortality for ES patients in the intensive care unit (ICU). Data were extracted from two large ICU databases: MIMIC-IV for training and internal validation, and eICU-CRD for external validation. We developed predictive models of ES mortality based on 15 ML algorithms. We relied on the synthetic minority oversampling technique (SMOTE) to address class imbalance. Our main performance metric was area under the ROC (AUROC). We adopted recursive feature elimination (RFE) for feature selection. We assessed model performance using three disease-severity scoring systems as benchmarks. Of the 1,566 and 207 ES patients enrolled in the two databases, there were 173 (15.70%), 73 (15.57%), and 36 (17.39%) hospital mortality in the training, internal validation, and external validation cohort, respectively. The random forest (RF) model had the largest AUROC (0.806) in the internal validation phase and was chosen as the best model. The AUROC of the RF compact (RF-COM) model containing the top six features identified by RFE was 0.795. In the external validation phase, the AUROC of the RF model was 0.838, and the RF-COM model was 0.830, outperforming other models. Our findings suggest that the RF model was the best model and the top six predictors of ES hospital mortality were Glasgow Coma Scale, white blood cell, blood urea nitrogen, bicarbonate, age, and mechanical ventilation.

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Admission Serum Bicarbonate Predicts Adverse Clinical Outcomes in Hospitalized Cirrhotic Patients

Cited by 4 publications

References 38 publications

Factors predicting mortality in patients with alcoholic liver cirrhosis visiting the emergency department

Factors predicting mortality in patients with alcoholic liver cirrhosis visiting the emergency department

Impact of Serum levels of Bicarbonate and Electrolytes on Adverse Clinical Outcomes in Cirrhotics

Identification of key predictors of hospital mortality in critically ill patients with embolic stroke using machine learning

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