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Liver, Pancreas and Biliary Tract| Volume 53, ISSUE 6, P738-745, June 2021

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Hyperkalemia influences the outcome of patients with cirrhosis with acute decompensation (AD) and acute-on-chronic liver failure (ACLF)

  • Gabriel Mezzano
    Affiliations
    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
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  • Andrés Cárdenas
    Affiliations
    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
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  • Ferrán Aguilar
    Affiliations
    EASL CLIF Consortium, European Foundation for the Study of Chronic Liver Failure, Barcelona, Spain
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  • Marco Pavesi
    Affiliations
    EASL CLIF Consortium, European Foundation for the Study of Chronic Liver Failure, Barcelona, Spain
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  • Cristina Solé
    Affiliations
    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
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  • Laura Napoleone
    Affiliations
    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
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  • Isabel Graupera
    Affiliations
    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

    Faculty of Medicine and health sciences, University of Barcelona
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  • Adrià Juanola
    Affiliations
    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
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  • Marta Carol
    Affiliations
    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

    Faculty of Medicine and health sciences, University of Barcelona
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  • Elisa Pose
    Affiliations
    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
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  • Nuria Fabrellas
    Affiliations
    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

    Faculty of Medicine and health sciences, University of Barcelona
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  • Ruben Hernaez
    Affiliations
    Section of Gastroenterology, Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX Center, Houston, TX, United States
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  • Javier Martínez
    Affiliations
    Department of Gastroenterology and Hepatology, Hospital Universitario Ramón y Cajal, Madrid, Spain
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  • Faouzi Saliba
    Affiliations
    AP-HP Hôpital Paul Brousse Centre Hépato-Biliaire, University Paris-Sud, Villejuif, France
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  • Vicente Arroyo
    Affiliations
    EASL CLIF Consortium, European Foundation for the Study of Chronic Liver Failure, Barcelona, Spain
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  • Elsa Sola
    Affiliations
    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
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  • Pere Gines
    Correspondence
    Corresponding author at: Liver Unit, Hospital Clinic, Spain.
    Affiliations
    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

    Faculty of Medicine and health sciences, University of Barcelona
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Published:January 11, 2021DOI:https://doi.org/10.1016/j.dld.2020.12.009

      Abstract

      Introduction

      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).

      Aim

      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.

      Methods

      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.

      Results

      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.

      Conclusions

      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.

      Keywords

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      Linked Article

      • Hyperkalemia and outcome of decompensated cirrhosis
        Digestive and Liver DiseaseVol. 53Issue 7
        • Preview
          We read with great interest this study performed by Mezzano et al. [1], which investigating the association between hyperkalemia (serum potassium ≥ 5.0 mEq/L) and mortality in patients with cirrhosis and acute decompensation (AD) with and without acute-on-chronic liver failure (ACLF). The results of this study involving 1314 participants demonstrated that hyperkalemia is a poor prognostic factor for mortality in patients with AD and ACLF, which provides new insights for the management of AD and ACLF patients.
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      • Hyperkalemia in patients with cirrhosis and acute-on-chronic liver failure
        Digestive and Liver DiseaseVol. 53Issue 7
        • Preview
          We sincerely thank Dr. Gong and Li for their comments [1]. We believe the presence of hyperkalemia in patients with acute decompensation and acute-on-chronic liver failure (ACLF) is an independent risk factor of mortality and the results of our analysis certainly call for future prospective studies [2].
        • Full-Text
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