Acid-base disturbances in critically ill patients with cirrhosis.
OBJECTIVE
The equilibrium of offsetting metabolic acid-base disorders in stable cirrhosis might be lost during episodes of hepatic decompensation, haemorrhage or sepsis. The purpose of this study was to determine whether the acid-base state is destabilized in critically ill patients with cirrhosis and whether this is associated with mortality.


METHODS
One-hundred and eighty-one consecutive patients with cirrhosis were investigated in a prospective observational cohort study on admission to a medical intensive care unit (ICU) of a university hospital. Arterial acid-base state was assessed according to the Gilfix methodology. Clinical data, ICU mortality and hospital mortality were recorded.


RESULTS
Patients had net metabolic acidosis owing to unmeasured anions and owing to hyperchloraemic, dilutional and lactic acidosis. Lactic acidosis, acidemia and acute renal failure on ICU admission were associated with increased mortality. Lactate and pH discriminated survivors from non-survivors. The presence of lactic acidosis could not always be recognized by customary acid-base parameters.


CONCLUSIONS
The stable equilibrium of acid-base disorders is lost when patients with cirrhosis become critically ill. Lactic acidosis and acidaemia are associated with increased ICU mortality caused by severe underlying organ dysfunction.
Funk
Georg Christian
GC
Department of Respiratory and Critical Care Medicine, Otto Wagner Spital, Vienna, Austria. georg-christian.funk@wienkav.at
Doberer
Daniel
D
Kneidinger
Nikolaus
N
Lindner
Gregor
G
Holzinger
Ulrike
U
Schneeweiss
Bruno
B
D018806:APACHE; D000136:Acid-Base Equilibrium; D000140:Acidosis, Lactic / Q000097:blood / Q000209:etiology* / Q000401:mortality / Q000503:physiopathology; D000328:Adult; D016638:Critical Illness; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D006863:Hydrogen-Ion Concentration; D007362:Intensive Care Units; D019344:Lactic Acid / Q000097:blood; D008103:Liver Cirrhosis / Q000097:blood / Q000150:complications / Q000401:mortality / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011446:Prospective Studies; D012372:ROC Curve; D012720:Severity of Illness Index
D019344:Lactic Acid