Positive fluid balance was associated with mortality in patients with acute-on-chronic liver failure: A cohort study

Cardoso, Filipe S.; Pereira, Rui; Laranjo, Ana; Gamelas, V; Bagulho, Luís; Germano, Nuno; Karvellas, Constantine J.

doi:10.1016/j.jcrc.2020.09.012

Cited by 13 publications

(9 citation statements)

References 31 publications

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“…Moreover, a restrictive fluid management was associated with a lower mortality compared to liberal fluid administration (24.7 vs. 33.2%; p < 0.0001) [6]. Similarly, in a cohort of critically ill patients with cirrhosis, a higher median fluid balance 7 days post-ICU admission (+13.50 vs. +6.90 L; p = 0.036) was associated with an increased risk of in-hospital mortality [7]. Interestingly, a recent clinical trial demonstrated that restrictive fluid management strategy is safe in patients with septic shock compared to standard care (i.e., liberal strategy); although the outcome was not superior in the restrictive group, it is notable that the standard care group received substantially less fluid compared to prior studies (a median of 3.8 L) [8].…”

Section: Introductionmentioning

confidence: 88%

Diagnosis of Fluid Overload: From Conventional to Contemporary Concepts

Koratala¹,

Ronco²,

Kazory³

2022

Cardiorenal Med

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Fluid overload has been associated with morbidity and mortality in various clinical scenarios including heart failure and critical illness. It exerts pathologic sequelae in almost all the organ systems. Proper management of patients with fluid overload requires knowledge of the underlying pathophysiology, objective evaluation of volume status, selection of appropriate therapeutic options, and maintenance and modulation of tissue perfusion. There are several methods to appraise volume status but none without limitations. In this review, we discuss the diagnostic utility, prognostic significance, and shortcomings of various bedside tools in the detection of fluid overload and evaluation of hemodynamic status. These include clinical examination, biomarkers, blood volume assessment, bioimpedance analysis, point-of-care ultrasound, and remote pulmonary pressure monitoring. In our opinion, clinicians must adopt a multiparametric approach offsetting the limitations of individual methods to formulate a management plan tailored to patients’ needs.

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Section: Introductionmentioning

confidence: 88%

Diagnosis of Fluid Overload: From Conventional to Contemporary Concepts

Koratala¹,

Ronco²,

Kazory³

2022

Cardiorenal Med

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“…Therefore, respiratory complications might be a major reason for the hesitation of clinicians to place mechanically ventilated patients on waiting lists for liver transplantation 2 . However, the appropriate management of respiratory complications in patients with severe LF remains obscure, although there are reports in the literature regarding possible clinical management options 2,11–18 …”

Section: Introductionmentioning

confidence: 99%

“…2 However, the appropriate management of respiratory complications in patients with severe LF remains obscure, although there are reports in the literature regarding possible clinical management options. 2,[11][12][13][14][15][16][17][18] This study was conducted with an aim to evaluate the management and treatment outcomes of patients with LF, especially those who needed mechanical ventilation therapy and are admitted to the general ICU.…”

mentioning

confidence: 99%

Outcomes of critically ill patients with liver failure who require mechanical ventilation: A retrospective, single‐center study

Mita,

Shimizu,

Ichiyama

et al. 2024

Health Science Reports

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Background and AimsCritically ill patients with liver failure have high mortality. Besides the management of organ‐specific complications, liver transplantation constitutes a definitive treatment. However, clinicians may hesitate to introduce mechanical ventilation for patients on liver transplantation waitlists because of poor prognosis. This study investigated the outcomes of intensive care and ventilation support therapy effects in patients with liver failure.MethodsThis single‐center study retrospectively enrolled 32 consecutive patients with liver failure who were admitted to the intensive care unit from January 2014 to December 2020. The medical records were reviewed and analyzed retrospectively for Acute Physiologic and Chronic Health Evaluation (APACHE)‐II. The model for end‐stage liver disease scores, 90‐day mortality, and survival was assessed using the Kaplan–Meier method.ResultsThe average patient age was 45.5 ± 20.1 years, and 53% of patients were women. On intensive care unit admission, APACHE‐II and model for end‐stage liver disease scores were 20 and 28, respectively. Among 13 patients considered for liver transplantation, 4 received transplants. Thirteen patients (40.6%) were intubated and mechanically ventilated in the intensive care unit. The 90‐day mortality rate of patients with and without mechanical ventilation in the intensive care unit (13, 61.5% vs. 19, 47.4%, p = 0.4905) was similar. APACHE‐II score >21 was an independent predictor of mechanical ventilation requirement in patients with liver failure during intensive care unit stay.ConclusionAlthough critically ill patients with liver failure are at risk of multiorgan failure with poor outcomes, mechanical ventilation did not negatively affect the 90‐day mortality or performance rates of liver transplantation. Clinicians should consider mechanical ventilation‐based life support in critically ill patients with liver failure who are awaiting liver transplantation.

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“…In 2017 alone, heart failure admissions occurred at a rate of approximately 5 per 1000 United States adults with about a quarter of those patients experiencing readmissions, which highlights the magnitude of this problem[ 3 ]. The deleterious effects of fluid overload are now being recognized outside of heart failure, with multiple studies showing a positive fluid balance being associated with increased mortality[ 4 , 5 ]. Though seemingly straightforward, evaluation and management of congestion require a thorough understanding of the pathophysiology and hemodynamic principles.…”

Section: Introductionmentioning

confidence: 99%

Point-of-care ultrasound in diagnosis and management of congestive nephropathy

Turk¹,

Robertson²,

Koratala³

2023

World J Crit Care Med

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Congestive nephropathy is kidney dysfunction caused by the impact of elevated venous pressures on renal hemodynamics. As a part of cardiorenal syndrome, the diagnosis is usually made based on history and physical examination, with findings such as jugular venous distension, a third heart sound, and vital signs as supporting findings. More recently, however, these once though objective measures have come under scrutiny for their accuracy. At the same time, bedside ultrasound has increased in popularity and is routinely being used by clinicians to take some of the guess work out of making the diagnosis of volume overload and venous congestion. In this mini-review, we will discuss some of the traditional methods used to measure venous congestion, describe the role of point-of-care ultrasound and how it can ameliorate a clinician’s evaluation, and offer a description of venous excess ultrasound score, a relatively novel scoring technique used to objectively quantify congestion. While there is a paucity of published large scale clinical trials evaluating the potential benefit of ultrasonography in venous congestion compared to gold standard invasive measurements, more study is underway to solidify the role of this objective measure in daily clinical practice.

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Positive fluid balance was associated with mortality in patients with acute-on-chronic liver failure: A cohort study

Cited by 13 publications

References 31 publications

Diagnosis of Fluid Overload: From Conventional to Contemporary Concepts

Diagnosis of Fluid Overload: From Conventional to Contemporary Concepts

Outcomes of critically ill patients with liver failure who require mechanical ventilation: A retrospective, single‐center study

Point-of-care ultrasound in diagnosis and management of congestive nephropathy

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