Mezzano Gabriel, Cárdenas Andrés, Aguilar Ferrán, Pavesi Marco, Solé Cristina, Napoleone Laura, Graupera Isabel, Juanola Adrià, Carol Marta, Pose Elisa, Fabrellas Nuria, Hernaez Ruben, Martínez Javier, Saliba Faouzi, Arroyo Vicente, Sola Elsa, Gines Pere
Liver Unit, Hospital Clinic, Spain; Institut d'Investigacions Biomediques August Pi I Sunyer (IDIBAPS), y Centro de Investigaciones en Red Hepaticas y Digestivas (CIBERehd), Barcelona, Catalonia, Spain.
Liver Unit, Hospital Clinic, Spain; Institut d'Investigacions Biomediques August Pi I Sunyer (IDIBAPS), y Centro de Investigaciones en Red Hepaticas y Digestivas (CIBERehd), Barcelona, Catalonia, Spain; GI Unit, Hospital Clinic, Spain; Faculty of Medicine and health sciences, University of Barcelona.
Dig Liver Dis. 2021 Jun;53(6):738-745. doi: 10.1016/j.dld.2020.12.009. Epub 2021 Jan 11.
The presence of hyperkalemia in different clinical scenarios has been described as a risk factor for mortality. Information about this electrolyte disorder in patients with cirrhosis is limited and there are no data in patients with acute-on-chronic liver failure (ACLF).
The aim of this study was to investigate whether hyperkalemia is a risk factor for mortality in patients with cirrhosis and acute decompensation (AD) with and without ACLF.
We performed an analysis of the Chronic Liver Failure Consortium CANONIC database in 1,314 consecutive patients admitted to 29 European centers with AD both with and without associated ACLF (294 and 1020 respectively). Hyperkalemia was defined as serum potassium ≥ 5.0 mEq/L. All patients had at least one valid measure of serum potassium from admission and/or through the whole hospitalization.
1314 patients were admitted with AD and 294 of them had ACLF at admission. Prevalence of hyperkalemia was significantly higher in ACLF versus AD (22.4% and 8.6% respectively, p<0.001). Hyperkalemia was associated with an increased 90, 180 and 360-day mortality risk in ACLF compared to AD (HR 10 vs 2.3 at 90-day p<0.001, 8.9 vs 3.1 at 180-day, p<0.001 and 5.8 vs 3.8 at 360-day, p<0.001). In a multivariate analysis, the presence of hyperkalemia during admission was independently associated with 90-day mortality [HR 2.4 (1.7 - 3.4)]. Variability of potassium between two valid measures ≥ 0.9 mg/dl was always also associated with a higher mortality rate. Addition of hyperkalemia to MELD score (MELD-K model) improved the accuracy to predict 90-day mortality risk.
Hyperkalemia is an independent risk factor of mortality in patients with AD and ACLF. Addition of hyperkalemia to the MELD score improves diagnostic accuracy to predict 90-day mortality in patients with AD and ACLF.
不同临床情况下高钾血症的存在已被描述为死亡的危险因素。关于肝硬化患者这种电解质紊乱的信息有限，而在慢加急性肝衰竭（ACLF）患者中尚无相关数据。
本研究旨在调查高钾血症是否为伴有或不伴有ACLF的肝硬化及急性失代偿（AD）患者死亡的危险因素。
我们对慢性肝衰竭联盟CANONIC数据库进行了分析，该数据库纳入了29个欧洲中心收治的1314例连续AD患者，其中伴有和不伴有相关ACLF的患者分别为294例和1020例。高钾血症定义为血清钾≥5.0 mEq/L。所有患者入院时和/或整个住院期间至少有一项有效的血清钾测量值。
1314例患者因AD入院，其中294例入院时患有ACLF。ACLF患者的高钾血症患病率显著高于AD患者（分别为22.4%和8.6%，p<0.001）。与AD相比，ACLF患者中高钾血症与90天、180天和360天死亡风险增加相关（90天时HR为10对2.3，p<0.001；180天时为8.9对3.1，p<0.001；360天时为5.8对3.8，p<0.001）。在多变量分析中，入院时高钾血症的存在与90天死亡率独立相关[HR 2.4（1.7 - 3.4）]。两次有效测量之间钾的变异性≥0.9 mg/dl也总是与较高的死亡率相关。将高钾血症纳入终末期肝病模型（MELD）评分（MELD-K模型）可提高预测90天死亡风险的准确性。
高钾血症是AD和ACLF患者死亡的独立危险因素。将高钾血症纳入MELD评分可提高预测AD和ACLF患者90天死亡率的诊断准确性。
