title: Moderate hyperkalemia in hospitalized patients with cirrhotic ascites indicates a poor prognosis.
abstract: OBJECTIVE
  Development of ascites in patients with liver cirrhosis is an ominous sign with a poor outcome. A liver transplantation must be considered, and it then becomes important to know if there are any factors indicating a worsened prognosis.
  
  
  METHODS
  We used official registers for a follow-up study of at least 5 years considering the prognosis of 155 prospectively recruited in-patients with cirrhotic ascites from medical units at nine Swedish university hospitals. All patients had undergone at least one diagnostic ascites tap, and had initially been questioned about background factors and physically examined according to a standardized case record form, followed by sampling of blood, urine, and ascites.
  
  
  RESULTS
  Death occurred within 1 year after inclusion in 53% of the cases, and was primarily liver-related in 70%. In a multivariable analysis, the two ordinary variables that showed the strongest correlation with risk of death were serum potassium and abdominal tenderness. All 22 patients with a serum potassium concentration of at least 4.8 mmol/L (maximum 5.8 mmol/L) died within 1 year after inclusion. Potassium concentration was related to renal function and potassium-saving drugs.
  
  
  CONCLUSIONS
  This follow-up study of a prospectively recruited cohort of in-patients with cirrhotic ascites confirms their poor prognosis. Awareness of an elevated serum potassium value, which would reflect a threatened renal function, seems essential, because it may offer a simple way to identify cases with the worst prognosis. An area for further research should be to explore the significance of including serum potassium in prognostic models.
authors.affiliation: Department of Medicine at Sahlgrenska University Hospital/Östra, Göteborg, Gothenburg, Sweden. sven.wallerstedt@gu.se
authors.forename: Sven
authors.initials: S
authors.lastname: Wallerstedt
authors.forename: Magnus
authors.initials: M
authors.lastname: Simrén
authors.forename: Staffan
authors.initials: S
authors.lastname: Wahlin
authors.forename: Lars
authors.initials: L
authors.lastname: Lööf
authors.forename: Rolf
authors.initials: R
authors.lastname: Hultcrantz
authors.forename: Klas
authors.initials: K
authors.lastname: Sjöberg
authors.forename: Hanna Sandberg
authors.initials: HS
authors.lastname: Gertzén
authors.forename: Hanne
authors.initials: H
authors.lastname: Prytz
authors.forename: Sven
authors.initials: S
authors.lastname: Almer
authors.forename: Anders
authors.initials: A
authors.lastname: Odén
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019540:Area Under Curve; D001201:Ascites / Q000097:blood* / Q000209:etiology; D058625:End Stage Liver Disease / Q000097:blood; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006947:Hyperkalemia / Q000097:blood* / Q000209:etiology; D008103:Liver Cirrhosis / Q000097:blood* / Q000150:complications; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016012:Poisson Distribution; D011379:Prognosis; D011446:Prospective Studies; D012372:ROC Curve; D012720:Severity of Illness Index