Unmeasured anions are associated with short-term mortality in patients with hypoxic hepatitis

TY - JOUR

T1 - Unmeasured anions are associated with short-term mortality in patients with hypoxic hepatitis

AU - Kneidinger, Nikolaus

AU - Funk, Georg-Christian

AU - Lindner, Gregor

AU - Drolz, Andreas

AU - Schenk, Peter

AU - Fuhrmann, Valentin

PY - 2013/8/1

Y1 - 2013/8/1

N2 - OBJECTIVE: Hypoxic hepatitis is a common cause of hepatic impairment in critically ill patients and is an independent risk factor for mortality. An elevated level of unmeasured anions is another unfavourable prognostic marker in many disease entities. While the biochemical nature of unmeasured anions is unknown, data suggest that they may be released from the liver. Therefore, the purpose of this study was to determine whether the strong ion gap-the gold standard for estimation of unmeasured anions-is elevated and associated with outcome in patients with hypoxic hepatitis.METHODS: One hundred and five consecutive patients with hypoxic hepatitis admitted to the (intensive care unit) ICU of a university hospital were prospectively included in the study and compared with 15 healthy controls.RESULTS: Compared with the controls, patients with hypoxic hepatitis had an elevated strong ion gap (4.0 ± 2.6 vs. 7.8 ± 4.0 mmol/L; p = 0.0002) that contributed to metabolic acidosis. Patients dying within 5 days had a larger strong ion gap upon admission than did patients surviving beyond 5 days. The mean strong ion gap (SIG) over the course of the first 5 days after admission to the ICU was 1.3 mmol/L (0.3-2.3 mmol/L) larger in patients who died compared with patients who survived, p = 0.008. In multivariate Cox-regression, larger strong ion gaps were associated with shorter survival time. The SIG correlated positively with both AST and ALT.CONCLUSIONS: Unmeasured anions are elevated in patients with hypoxic hepatitis, contribute to metabolic acidosis and are associated with mortality. The liver is a possible source of the unmeasured anions, which may represent markers of tissue damage in hypoxic hepatitis.

AB - OBJECTIVE: Hypoxic hepatitis is a common cause of hepatic impairment in critically ill patients and is an independent risk factor for mortality. An elevated level of unmeasured anions is another unfavourable prognostic marker in many disease entities. While the biochemical nature of unmeasured anions is unknown, data suggest that they may be released from the liver. Therefore, the purpose of this study was to determine whether the strong ion gap-the gold standard for estimation of unmeasured anions-is elevated and associated with outcome in patients with hypoxic hepatitis.METHODS: One hundred and five consecutive patients with hypoxic hepatitis admitted to the (intensive care unit) ICU of a university hospital were prospectively included in the study and compared with 15 healthy controls.RESULTS: Compared with the controls, patients with hypoxic hepatitis had an elevated strong ion gap (4.0 ± 2.6 vs. 7.8 ± 4.0 mmol/L; p = 0.0002) that contributed to metabolic acidosis. Patients dying within 5 days had a larger strong ion gap upon admission than did patients surviving beyond 5 days. The mean strong ion gap (SIG) over the course of the first 5 days after admission to the ICU was 1.3 mmol/L (0.3-2.3 mmol/L) larger in patients who died compared with patients who survived, p = 0.008. In multivariate Cox-regression, larger strong ion gaps were associated with shorter survival time. The SIG correlated positively with both AST and ALT.CONCLUSIONS: Unmeasured anions are elevated in patients with hypoxic hepatitis, contribute to metabolic acidosis and are associated with mortality. The liver is a possible source of the unmeasured anions, which may represent markers of tissue damage in hypoxic hepatitis.

KW - Acidosis

KW - Anions

KW - Anoxia

KW - Austria

KW - Biological Markers

KW - Comorbidity

KW - Female

KW - Hepatitis

KW - Humans

KW - Hydrogen-Ion Concentration

KW - Incidence

KW - Male

KW - Middle Aged

KW - Prognosis

KW - Risk Factors

KW - Survival Analysis

KW - Survival Rate

U2 - 10.1007/s00508-013-0400-9

DO - 10.1007/s00508-013-0400-9

M3 - SCORING: Journal article

C2 - 23860697

VL - 125

SP - 474

EP - 480

JO - WIEN KLIN WOCHENSCHR

JF - WIEN KLIN WOCHENSCHR

SN - 0043-5325

IS - 15-16

ER -