Impact of Serum levels of Bicarbonate and Electrolytes on Adverse Clinical Outcomes in Cirrhotics

Abstract

Background: It is well known that acid-base imbalances and low serum bicarbonate are linked to increased illness severity. Aim: To examine the prognostic significance of information obtained from arterial blood gas (ABG)-related parameters and serum electrolytes at the time of hospital admission on adverse clinical outcomes, the length of LOS, and other factors. Methods: A total of 357 candidate individuals with liver cirrhosis were screened for enrollment in this prospective study. 329 patients agreed to participate who had evidence of liver cirrhosis or presented with signs and symptoms suggesting decompensated liver cirrhosis. Individuals with diabetes ketoacidosis, acute coronary syndrome, fulminant liver failure, preexisting end-stage renal disease, or chronic obstructive pulmonary disease (a total of 208) weren't involved in the research. Then, 121 patients who were hospitalized in the Internal Medicine department or treated in ICU with a confirmed diagnosis of decompensated cirrhosis (age ≥ 18 years) were prospectively recruited and monitored throughout the research period. Results: This research involved 121 cases with a confirmed diagnosis of cirrhosis. Regarding the PH, normal PH were 76 (62.8%) patients, acidemia 22 (18.2%), alkalemia 23 (18.2). There were 73 (60.4%) patients were child C score at time of admission. The mean MELD score was 19.26± 9.01. The mean MELD-PaCO2-HCO3 was 23.79 ± 7.45 while the mean MELD-bicarbonate was 16.35±7.22 . As a regimen of management, serum electrolyte acid base correction was used in 33 (27.3%) cases, while endoscopy or band ligation was performed in 40 (33.1%) cases. Medication for Na and K correction were used in 6 (5%) and 17 (14%) cases respectively. Vasopressors were used in 12 (9.9%) cases who were admitted to the ICU. None of the cases underwent renal replacement therapy. Conclusion: The high incidence of metabolic acidosis and the frequency of organ failures are strong predictors of death in critically ill individuals with cirrhosis, leading to a poor prognosis and a high mortality rate.