Lactate Improves Prediction of Short‐Term Mortality in Critically Ill Patients With Cirrhosis

Drolz, Andreas; Horvatits, Thomas; Rutter, Karoline; Landahl, Felix; Roedl, Kevin; Meersseman, Philippe; Wilmer, Alexander; Kluwe, Johannes; Lohse, Ansgar W.; Kluge, Stefan; Trauner, Michael; Fuhrmann, Valentin

doi:10.1002/hep.30151

Cited by 103 publications

(138 citation statements)

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“…Management of liver injury in critical illness represents a major multidisciplinary challenge. Liver injury in critical illness may be divided into groups: On the one hand, liver cirrhosis and subsequent acute‐on‐chronic liver failure (ACLF) and primary acute liver failure (ALF) are well‐known entities of primary hepatic dysfunction . However, secondary or acquired liver injury and failure (primarily without underlying liver disease) such as hypoxic liver injury (HLI), cholestatic dysfunction in critical illness, sclerosing cholangitis in critical illness (SC‐CIP), and drug‐induced liver injury (DILI) represent by far the most frequent forms of hepatic injury in critical illness.…”

Section: Prevalence and Outcome Of Different Liver Disease Entities Amentioning

confidence: 99%

“…Liver injury in critical illness may be divided into groups: On the one hand, liver cirrhosis and subsequent acute-on-chronic liver failure (ACLF) and primary acute liver failure (ALF) are well-known entities of primary hepatic dysfunction. (4)(5)(6)(7)(8) However, secondary or acquired liver injury and failure (primarily without underlying liver disease) such as hypoxic liver injury (HLI), cholestatic dysfunction in critical illness, sclerosing cholangitis in critical illness (SC-CIP), and drug-induced liver injury (DILI) represent by far the most frequent forms of hepatic injury in critical illness. Although liver failure in the absence of chronic liver diseases refers primarily to the unique entity of ALF, defined as onset of hepatic encephalopathy and hepatic coagulopathy in patients without underlying liver disease (despite some exceptions), secondary forms of liver injury can also fulfill diagnostic criteria of ALF and are consequently incorporated into the recent European guidelines on ALF.…”

Section: Liver Injury and Failure In Critical Illnessmentioning

confidence: 99%

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Liver Injury and Failure in Critical Illness

et al. 2019

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The frequency of acquired liver injury and failure in critical illness has been significantly increasing over recent decades. Currently, liver injury and failure are observed in up to 20% of patients in intensive care units and are associated with significantly increased morbidity and mortality. Secondary forms of liver injury in critical illness are divided primarily into cholestatic, hypoxic, or mixed forms. Therefore, sufficient knowledge of underlying alterations (e.g., hemodynamic, inflammatory, or drug induced) is key to a better understanding of clinical manifestations, prognostic implications, as well as diagnostic and therapeutic options of acquired liver injury and failure. This review provides a structured approach for the evaluation and treatment of acquired liver injury and failure in critically ill patients.

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Section: Prevalence and Outcome Of Different Liver Disease Entities Amentioning

confidence: 99%

Section: Liver Injury and Failure In Critical Illnessmentioning

confidence: 99%

Liver Injury and Failure in Critical Illness

et al. 2019

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“…Lactate levels were independently associated with short-term mortality in critically ill patients with liver cirrhosis and were shown to significantly improve performance of CLIF-C ACLF. The modified called CLIF-C ACLFsLact score remains to be evaluated in an external cohort 41 together with the numerous biomarkers that have recently been associated with outcomes in this population. [42][43][44][45][46][47] Combining available scores with biomarkers could optimize prediction of events in this population with a high short-term mortality.…”

Section: Key Pointsmentioning

confidence: 99%

Approaches for patients with very high MELD scores

Artru

Samuel

2019

JHEP Reports

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In the era of the "sickest first" policy, patients with very high model for end-stage liver disease (MELD) scores have been increasingly admitted to the intensive care unit with the expectation that they will receive a liver transplant (LT) in the absence of improvement on supportive therapies. Such patients are often admitted in a context of acute-on-chronic liver failure with extrahepatic failures. Sequential assessment of scores or classification based on organ failures within the first days after admission help to stratify the risk of mortality in this population. Although the prognosis of severely ill cirrhotic patients has recently improved, transplant-free mortality remains high. LT is still the only curative treatment in this population. Yet, the increased relative scarcity of graft resource must be considered alongside the increased risk of losing a graft in the initial postoperative period when performing LT in "too sick to transplant" patients. Variables associated with poor immediate post-LT outcomes have been identified in large studies. Despite this, the performance of scores based on these variables is still insufficient. Consideration of a patient's comorbidities and frailty is an appealing predictive approach in this population that has proven of great value in many other diseases. So far, local expertise remains the last safeguard to LT. Using this expertise, data are accumulating on favourable post-LT outcomes in very high MELD populations, particularly when LT is performed in a situation of stabilization/improvement of organ failures in selected candidates. The absence of "definitive" contraindications and the control of "dynamic" contraindications allow a "transplantation window" to be defined. This window must be identified swiftly after admission given the poor short-term survival of patients with very high MELD scores. In the absence of any prospect of LT, withdrawal of care could be discussed to ensure respect of patient life, dignity and wishes.

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“…On the one hand, hyperglycemia is always associated with hyperlactatemia [9,10], increasing morbidity and mortality in acute critical illness [11,12]. A previous confirmed that lactate levels might appropriately reflect the severity of disease and organ failure, and also were independently associated with short-term mortality in critically ill patients with liver cirrhosis [13]. Although anaerobic glycolysis increases the substrate, however, suppressing hyperglycemia generating 2,3diphosphoglycerate, absolute insulin secretion, or relatively insufficient may lead to an increase in plasma free fatty acid concentration, and fatty acid can increase the myocardial oxygen consumption.…”

Section: Discussionmentioning

confidence: 99%

The prognostic value of postoperative blood glucose in non-diabetic patients with rheumatic heart disease

Hong

Wang

et al. 2019

Preprint

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Background: Blood glucose (BG) is a risk factor of adverse prognosis in non-diabetic patients in several conditions. However, a limited number of studies were performed to explore the relationship between postoperative BG and adverse outcomes in non-diabetic patients with rheumatic heart disease (RHD). Methods: We identified 1395 non-diabetic patients who diagnosed with having RHD, and underwent at least one valve replacement and preoperative coronary angiography. BG was measured at admission to the intensive care unit (ICU) after surgery. The association of postoperative BG level with in-hospital and one-year mortality was accordingly analyzed. Results: Included patients were stratified into four groups according to postoperative BG level’s (mmol/L) quartiles: Q1 (< 9.3 mmol/L, n=348), Q2 (9.3-10.9 mmol/L, n=354), Q3 (10.9-13.2 mmol/L, n=341), and Q4 (≥ 13.2 mmol/L, n=352). The in-hospital death (1.1% vs. 2.3% vs. 1.8% vs. 8.2%, P<0.001) and MACEs (2.0% vs. 3.1% vs. 2.6% vs. 9.7%, P<0.001) were significantly higher in the upper quartiles. Postoperative BG > 13.0 mmol/L was the best threshold for predicting in-hospital death (area under the curve (AUC) = 0.707, 95% confidence interval (CI): 0.634-0.780, P<0.001). Multivariate logistic regression analysis indicated that postoperative BG > 13.0 mmol/L was an independent predictor of in-hospital mortality (adjusted odds ratio (OR) = 3.418, 95% CI: 1.713–6.821, P<0.001). In addition, Kaplan–Meier curve analysis showed that the risk of one-year death was increased for a postoperative BG > 13.2 (log-rank = 32.762, P<0.001). Conclusion: Postoperative BG, as a routine test, could be served as a risk measure for non-diabetic patients with RHD.

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Lactate Improves Prediction of Short‐Term Mortality in Critically Ill Patients With Cirrhosis

Cited by 103 publications

References 48 publications

Liver Injury and Failure in Critical Illness

Liver Injury and Failure in Critical Illness

Approaches for patients with very high MELD scores

The prognostic value of postoperative blood glucose in non-diabetic patients with rheumatic heart disease

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