Gao Feng, Lin Miao-Tong, Yang Xing-Yi, Cai Meng-Xing, Nan Hao, Xie Wei, Huang Zhi-Ming
Department of Gastroenterology and Hepatology, the First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China.
Department of Emergency Medicine, Intensive Care, the First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China.
Turk J Gastroenterol. 2019 Oct;30(10):883-891. doi: 10.5152/tjg.2019.18813.
BACKGROUND/AIMS: Metabolic acidosis is a common complication in patients with cirrhosis at the intensive care units (ICUs) and associated with increased mortality. The aim of our research was to explore the epidemiology and risk factors of metabolic acidosis in critically ill patients with cirrhosis.
A total of 975 patients with cirrhosis were selected into our study, and all participants were followed up for at least 28 days. Cox regression model and machine-learning algorithm were used to identify the importance of different risk factors, respectively. Finally, an improved prognostic model as Model for End-stage Liver Disease and metabolic acidosis (MELD-MA) was developed.
Among the 975 patients with liver cirrhosis, 506 had metabolic acidosis, including 257 patients who had decompensated metabolic acidosis at ICU admission. The 28-day mortality was 41% (206/506) in patients with metabolic acidosis. Bilirubin (hazard ratio (HR): 1.023, 95% confidence interval (CI): 1.011-1.036), international normalized ratio (HR: 1.527, 95% CI: 1.332-1.750), pH (HR: 0.173, 95% CI: 0.047-0.640), BE-Lac (HR: 0.907, 95% CI: 0.868-0.948), and BE-Na (HR: 0.923, 95% CI: 0.859-0.991) were considered as independent prognostic parameters for 28-day mortality. MELD-NA had significantly higher discrimination (area under the receiver operating characteristic curve 0.79) than MELD and Child-Pugh score.
Critically ill patients with cirrhosis have a high mortality rate and poor prognosis because of the high prevalence of metabolic acidosis. Lactic acidosis is the worst prognosis of all types of metabolic acidosis. MELD-MA performs well on the short-term mortality assessment in critically ill patients with cirrhosis and metabolic acidosis.
背景/目的：代谢性酸中毒是重症监护病房（ICU）肝硬化患者的常见并发症，与死亡率增加相关。本研究的目的是探讨肝硬化重症患者代谢性酸中毒的流行病学及危险因素。
共纳入975例肝硬化患者进行研究，所有参与者均随访至少28天。分别采用Cox回归模型和机器学习算法确定不同危险因素的重要性。最后，开发了一种改进的预后模型，即终末期肝病与代谢性酸中毒模型（MELD-MA）。
975例肝硬化患者中，506例发生代谢性酸中毒，其中257例在ICU入院时存在失代偿性代谢性酸中毒。代谢性酸中毒患者的28天死亡率为41%（206/506）。胆红素（风险比（HR）：1.023，95%置信区间（CI）：1.011 - 1.036）、国际标准化比值（HR：1.527，95%CI：1.332 - 1.750）、pH值（HR：0.173，95%CI：0.047 - 0.640）、碱剩余-乳酸（HR：0.907，95%CI：0.868 - 0.948）和碱剩余-钠（HR：0.923，95%CI：0.859 - 0.991）被认为是28天死亡率的独立预后参数。MELD-NA的辨别力（受试者工作特征曲线下面积为0.79）显著高于MELD和Child-Pugh评分。
肝硬化重症患者因代谢性酸中毒的高发生率而死亡率高、预后差。乳酸酸中毒是所有类型代谢性酸中毒中预后最差的。MELD-MA在肝硬化合并代谢性酸中毒重症患者的短期死亡率评估中表现良好。
