Bicarbonate can improve the prognostic value of the MELD score for critically ill patients with cirrhosis

Abstract

The prognosis of critically ill patients with cirrhosis is poor. Our aim was to identify an objective variable that can improve the prognostic value of the Model of End-Stage Liver Disease (MELD) score in patients who have cirrhosis and are admitted to the intensive care unit (ICU). This retrospective cohort study included 177 patients who had liver cirrhosis and were admitted to the ICU. Data pertaining to arterial blood gas-related parameters and other variables were obtained on the day of ICU admission. The overall ICU mortality rate was 36.2%. The bicarbonate (HCO3) level was found to be an independent predictor of ICU mortality (odds ratio, 2.3; 95% confidence interval [CI], 1.0-4.8; p = 0.038). A new equation was constructed (MELD-Bicarbonate) by replacing total bilirubin by HCO3 in the original MELD score. The area under the receiver operating characteristic curve for predicting ICU mortality was 0.76 (95% CI, 0.69-0.84) for the MELD-Bicarbonate equation, 0.73 (95% CI, 0.65-0.81) for the MELD score, and 0.71 (95% CI, 0.63-0.80) for the Acute Physiology and Chronic Health Evaluation II score. Bicarbonate level assessment, as an objective and reproducible laboratory test, has significant predictive value in critically ill patients with cirrhosis. In contrast, the predictive value of total bilirubin is not as prominent in this setting. The MELD-Bicarbonate equation, which included three variables (international normalized ratio, creatinine level, and HCO3 level), showed better prognostic value than the original MELD score in critically ill patients with cirrhosis.

Admission Serum Bicarbonate Predicts Adverse Clinical Outcomes in Hospitalized Cirrhotic Patients

“…[ 4 ] In a follow-up study of 185 cirrhotic patients admitted to the ICU, the SB had prognostic significance for 7-day mortality [ 14 ]. Finally, the SB level on admission was an independent predictor of ICU mortality in 177 critically ill patients with cirrhosis, and replacement of the bilirubin level with the SB level to create a “MELD-bicarbonate” score actually outperformed the original MELD score in predicting mortality [ 13 ].…”

“…e significance of SB in cirrhosis has only received limited attention. Most studies have assessed the impact of increased serum lactate levels and unmeasured anion acidosis on ICU mortality [3,4,[10][11][12], whereas only three studies have evaluated SB as a prognostic marker [4,13,14]. 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.…”

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

“…The relation between Na and different categorical parameters is shown in table (10). This table shows that there was significant variation among the three groups concerning, ascites (p=0.016), Child -Pugh score (p=0.019), encephalopathy (p=0.023), ICU admission (p=0.045) and course (p=0.034).…”

A Systematic Review and Meta-Analysis of the Prevalence of Triplex Infections (Combined Human Immunodeficiency Virus, Hepatitis B Virus, and Hepatitis C Virus) among Pregnant Women in Nigeria

“…The prevalence of triplex infection in the obstetric population was pooled, and the percentage (with a 95% confidence interval) was utilized as the effect size. The pooled effect was then calculated using the generic inverse variance approach, because the effect of a single rate and its standard error are similar to the rate difference (RD) at this time [ 15 ]. The Q test and forest plots were used to evaluate the degree of study heterogeneity.…”