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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Article info
Publication history
Published online: January 11, 2021
Accepted:
December 15,
2020
Received:
October 4,
2020
Identification
Copyright
© 2020 Editrice Gastroenterologica Italiana S.r.l. Published by Elsevier Ltd. All rights reserved.
ScienceDirect
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- Hyperkalemia and outcome of decompensated cirrhosisDigestive and Liver DiseaseVol. 53Issue 7
- PreviewWe 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 failureDigestive and Liver DiseaseVol. 53Issue 7
- PreviewWe 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].
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