Introduction
Materials and methods
Patients
Continuous venovenous hemodialysis treatment
Statistical analysis
Results
Patient characteristics
Minimum | 25th percentile | Median | 75th percentile | Maximum | Normal range | |
---|---|---|---|---|---|---|
MELD score (points) | 19 | 28 | 36 | 40 | 40 | Maximum 40 points |
Child-Pugh score (points) | 9 | 10 | 12 | 13 | 14 | Maximum 15 points |
SAPS II (points) | 25 | 35 | 42 | 53 | 69 | Maximum 137 points |
TISS score (points) | 10 | 14 | 17 | 22 | 46 | Maximum 47 points |
ICG-PDR (%) | 1.5 | 3.2 | 3.6 | 5.1 | 17.5 | 18 to 25 |
Prothrombin time (%) | 15 | 29 | 37 | 44 | 81 | 70 to 120 |
Cholinesterase (U/l) | 584 | 1,110 | 1,770 | 2,412 | 6,417 | 5,320 to 12,920 |
Albumin (g/dl) | 1.8 | 2.6 | 3.2 | 3.7 | 5.0 | 3.5 to 5 |
Bilirubin (mg/dl) | 0.7 | 2.6 | 12.0 | 22.5 | 46.1 | <1.2 |
ASAT (U/l) | 31 | 62 | 80 | 122 | 1859 | 10 to 50 |
ALAT (U/l) | 13 | 30 | 49 | 77 | 598 | 10 to 35 |
Lactate (mmol/l) | 0.7 | 1.7 | 2.2 | 3.4 | 10.0 | <2.4 |
Acute kidney injury
Minimum | 25th percentile | Median | 75th percentile | Maximum | |
---|---|---|---|---|---|
Creatinine at hospital admission (mg/dl) | 0.6 | 1.3 | 2.0 | 3.2 | 5.9 |
Urea at hospital admission (mg/dl) | 3 | 27 | 45 | 87 | 138 |
Creatinine at ICU admission (mg/dl) | 1.2 | 2.2 | 2.9 | 4.7 | 5.9 |
Urea at ICU admission (mg/dl) | 16 | 34 | 52 | 91 | 135 |
24-hour urine production (ml) at ICU admission | 0 | 100 | 400 | 1,000 | 2,900 |
Creatinine at first CVVHD (mg/dl) | 0.8 | 2.4 | 3.4 | 5.2 | 46.0 |
Urea at first CVVHD (mg/dl) | 29 | 50 | 70 | 116 | 181 |
Length of stay (days) at ICU until first CVVHD | 0 | 2 | 4 | 8 | 20 |
Red blood cell units transfused before first CVVHD | 0 | 0 | 2 | 4 | 14 |
Fresh frozen plasma units transfused before first CVVHD | 0 | 0 | 4 | 10 | 26 |
Noradrenaline (μg/hour) at CVVHD start | 0 | 100 | 300 | 900 | 30,000 |
Noradrenaline (μg/hour) at CVVHD end | 0 | 0 | 300 | 900 | 30,000 |
Terlipressine (μg/hour) at CVVHD start | 0 | 0 | 0 | 80 | 240 |
Terlipressine (μg/hour) at CVVHD end | 0 | 0 | 0 | 40 | 240 |
Filter lifetime
Acid-base status and electrolyte balance during CVVHD treatment
Minimum | 25th percentile | Median | 75th percentile | Maximum | |
---|---|---|---|---|---|
pH baseline | 7.11 | 7.21 | 7.29 | 7.34 | 7.43 |
pH 24 hours | 7.21 | 7.27 | 7.33 | 7.41 | 7.51 |
pH 72 hours | 7.13 | 7.30 | 7.40 | 7.44 | 7.50 |
Bicarbonate baseline | 12.4 | 18.3 | 20.4 | 22.9 | 27.9 |
Bicarbonate 24 hours | 13.9 | 22.2 | 24.1 | 25.5 | 29.0 |
Bicarbonate 72 hours | 12.9 | 23.9 | 26.5 | 27.8 | 31.8 |
Base excess baseline | -14.2 | -7.5 | -5.0 | -3.2 | 2.5 |
Base excess 24 hours | -12.4 | -3.4 | -1.0 | 1.0 | 4.3 |
Base excess 72 hours | -17.5 | -2.2 | 1.2 | 3.5 | 7.7 |
Anion gap baseline | 6 | 10 | 13 | 15 | 28 |
Anion gap 24 hours | 3 | 9 | 11 | 15 | 24 |
Anion gap 72 hours | 4 | 9 | 11 | 13 | 28 |
pCO2 baseline | 20 | 39 | 48 | 54 | 80 |
pCO2 24 hours | 29 | 40 | 49 | 55 | 70 |
pCO2 72 hours | 30 | 43 | 46 | 55 | 86 |
Caion baseline | 0.91 | 1.14 | 1.21 | 1.26 | 1.41 |
Caion 24 hours | 1.02 | 1.15 | 1.18 | 1.22 | 1.33 |
Caion 72 hours | 1.00 | 1.11 | 1.15 | 1.19 | 1.26 |
Sodium baseline | 126 | 136 | 139 | 144 | 157 |
Sodium 24 hours | 136 | 140 | 141 | 143 | 153 |
Sodium 72 hours | 133 | 142 | 143 | 145 | 151 |
Chloride 0 | 94 | 105 | 109 | 113 | 127 |
Chloride 24 hours | 97 | 106 | 108 | 111 | 120 |
Chloride 72 hours | 102 | 107 | 109 | 110 | 115 |
Prediction of citrate accumulation in terms of Catot/Caion ratio ≥2.5 by baseline liver function parameters
Citrate accumulation in serum
Discussion
Conclusions
Key messages
-
Substantial accumulation of citrate in serum of liver failure patients is observed during CVVHD treatment.
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Citrate in serum correlates with the Catot/Caion ratio in liver failure patients.
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For daily clinical practice, the Catot/Caion ratio might be more useful for the detection of citrate accumulation compared with citrate, because clear cutoff values for citrate in serum are missing.
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A prothrombin time ≤26% and serum lactate ≥3.4 mmol/l might be risk factors for citrate accumulation in liver failure patients in whom closer monitoring of the acid-base and electrolyte status is mandatory to ensure patient safety.
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CVVHD using citrate for regional anticoagulation in liver failure patients is feasible.