Sun Dan-Qin, Zhang Lai, Zheng Chen-Fei, Liu Wen-Yue, Zheng Kenneth I, Chen Xiao-Ming, Zheng Ming-Hua, Yuan Wei-Jie
Department of Nephrology, The Affiliated Wuxi No. 2 People's Hospital of Nanjing Medical University, Wuxi, China.
Department of Nephrology, Shanghai General Hospital of Nanjing Medical University, Shanghai, China.
J Clin Transl Hepatol. 2019 Jun 28;7(2):112-121. doi: 10.14218/JCTH.2019.00013. Epub 2019 May 20.
The metabolic acid-base disorders have a high incidence of acute kidney injury (AKI) in critically ill cirrhotic patients (CICPs). The aims of our study were to ascertain the composition of metabolic acidosis of CICPs with AKI and explore its relationship with hospital mortality. Three-hundred and eighty consecutive CICPs with AKI were eligible for the cohort study. Demographic, clinical and laboratory parameters were recorded and arterial acid-base state was analyzed by the Stewart and Gilfix methodology. Net metabolic acidosis, lactic acidosis, acidosis owing to unmeasured anions, acidemia, and dilutional acidosis were less frequent in the non-survival group compared to the survival group of CICPs. The presence of acidemia, acidosis owing to unmeasured anions, and lactic acidosis were independently associated with increased risk of intensive care unit 30-day mortality, with hazard ratios of 2.11 (95% confidence interval (CI): 1.43-3.12), 3.38 (95% CI: 2.36-4.84), and 2.16 (95% CI: 1.47-3.35), respectively. After full adjustment for confounders, the relationship between acidosis owing to unmeasured anions with hospital mortality was still significant, with hazard ratio of 2.29 (95% CI: 1.22-4.30). Furthermore, arterial lactate concentration in combination with chronic liver failure-sequential organ failure assessment and BE had the strongest ability to differentiate 30-day mortality (area under the receiver operating characteristic curve: 0.79, 95% CI: 0.74-0.83). CICPs with AKI exhibit a complex metabolic acidosis during intensive care unit admission. Lactic acidosis and BE, novel markers of acid-base disorders, show promise in predicting mortality rate of CICPs with AKI.
代谢性酸碱紊乱在重症肝硬化患者（CICPs）中急性肾损伤（AKI）的发生率很高。我们研究的目的是确定合并AKI的CICPs代谢性酸中毒的构成，并探讨其与医院死亡率的关系。连续380例合并AKI的CICPs符合队列研究条件。记录人口统计学、临床和实验室参数，并采用Stewart和Gilfix方法分析动脉酸碱状态。与CICPs存活组相比，非存活组的净代谢性酸中毒、乳酸酸中毒、未测定阴离子引起的酸中毒、酸血症和稀释性酸中毒发生率较低。酸血症、未测定阴离子引起的酸中毒和乳酸酸中毒的存在与重症监护病房30天死亡率增加独立相关，风险比分别为2.11（95%置信区间（CI）：1.43 - 3.12）、3.38（95%CI：2.36 - 4.84）和2.16（95%CI：1.47 - 3.35）。在对混杂因素进行充分校正后，未测定阴离子引起的酸中毒与医院死亡率之间的关系仍然显著，风险比为2.29（95%CI：1.22 - 4.30）。此外，动脉乳酸浓度与慢性肝功能衰竭 - 序贯器官衰竭评估及碱剩余相结合，具有最强的区分30天死亡率的能力（受试者操作特征曲线下面积：0.79，95%CI：0.74 - 0.83）。合并AKI的CICPs在入住重症监护病房期间表现出复杂的代谢性酸中毒。乳酸酸中毒和碱剩余作为酸碱紊乱的新标志物，在预测合并AKI的CICPs死亡率方面显示出前景。
