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Characteristics, Risk Factors, and Adverse Outcomes of Hyperkalemia in Acute-on-Chronic Liver Failure Patients

Jun-Jun Cai1, Kai Wang2,3, Hui-Qing Jiang1

  • 1Department of Gastroenterology, The Second Hospital of Hebei Medical University, Hebei Key Laboratory of Gastroenterology, Hebei Institute of Gastroenterology, Shijiazhuang, China.

Biomed Research International
|April 3, 2019
PubMed

Insights

Hyperkalemia significantly increases 90-day mortality in patients with acute-on-chronic liver failure (ACLF). This complication is strongly linked to acute kidney injury (AKI), with combined AKI and hyperkalemia leading to the worst outcomes.

Area of Science:

  • Hepatology
  • Nephrology
  • Critical Care Medicine

Background:

  • Hyperkalemia is a known complication in cirrhosis, but its specific role in acute-on-chronic liver failure (ACLF) remains understudied.
  • Understanding hyperkalemia's risk factors and impact on ACLF patient outcomes is crucial for improving clinical management.

Purpose of the Study:

  • To investigate the clinical characteristics and risk factors of hyperkalemia in ACLF patients.
  • To determine the impact of hyperkalemia on 90-day mortality in ACLF patients, particularly in the context of acute kidney injury (AKI).

Main Methods:

  • Retrospective analysis of 650 ACLF patients.
  • Multivariable regression models were used to identify risk factors for hyperkalemia and its association with 90-day mortality.

Main Results:

  • 12.2% of ACLF patients developed hyperkalemia during hospitalization.
  • Acute kidney injury (AKI) and higher admission serum potassium were independent risk factors for hyperkalemia.
  • Hyperkalemia independently predicted 90-day mortality in both AKI and non-AKI ACLF patients, with significantly higher mortality rates observed in hyperkalemic patients.
  • Hepatic encephalopathy, gastrointestinal bleeding, AKI, hyperkalemia, elevated TBIL and INR, and higher MELD and CLIF-SOFA scores were independent predictors of 90-day mortality.

Conclusions:

  • Hyperkalemia is an independent predictor of increased 90-day mortality in ACLF patients.
  • Hyperkalemia is significantly associated with AKI in ACLF.
  • The combination of AKI and hyperkalemia confers the poorest prognosis in ACLF patients.
Abstract

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