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AI InsightMELD-MA performs well on the short-term mortalityassessment in critically ill patients with cirrhosis and metabolic acidosis.
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Özet
Background/Aims: Metabolic acidosis is a common complication in patients with cirrhosis at the intensive care units (ICUs) and associated with increased mortality. The aim of our research was to explore the epidemiology and risk factors of metabolic acidosis in criticallyill patients with cirrhosis.Materials and Methods: A total of 975 patients with cirrhosis were selected into our study, and all participants were followed up for at least28 days. Cox regression model and machine-learning algorithm were used to identify the importance of different risk factors, respectively.Finally, an improved prognostic model as Model for End-stage Liver Disease and metabolic acidosis (MELD-MA) was developed.Results: Among the 975 patients with liver cirrhosis, 506 had metabolic acidosis, including 257 patients who had decompensatedmetabolic acidosis at ICU admission. The 28-day mortality was 41% (206/506) in patients with metabolic acidosis. Bilirubin (hazardratio (HR): 1.023, 95% confidence interval (CI): 1.011-1.036), international normalized ratio (HR: 1.527, 95% CI: 1.332-1.750), pH (HR:0.173, 95% CI: 0.047-0.640), BE-Lac (HR: 0.907, 95% CI: 0.868-0.948), and BE-Na (HR: 0.923, 95% CI: 0.859-0.991) were consideredas independent prognostic parameters for 28-day mortality. MELD-NA had significantly higher discrimination (area under the receiveroperating characteristic curve 0.79) than MELD and Child-Pugh score.Conclusion: Critically ill patients with cirrhosis have a high mortality rate and poor prognosis because of the high prevalence of metabolic acidosis. Lactic acidosis is the worst prognosis of all types of metabolic acidosis. MELD-MA performs well on the short-term mortalityassessment in critically ill patients with cirrhosis and metabolic acidosis.