Albumin use, AKI, infections predict respiratory failure in patients with cirrhosis

Some hospitalized patients with cirrhosis who are not exposed to terlipressin develop respiratory failure (RF), reveals a study.

The highest RF risk exists in those admitted with acute kidney injury (AKI), those with gastrointestinal (GI) bleeding on admission, and those who developed nosocomial infections and other organ failures or received albumin during their hospital stay.

This study prospectively enrolled a multicentre North American cirrhosis inpatient cohort. Admission and in-hospital data (grading per European Association for the Study of Liver-Chronic Liver Failure scoring system, AKI, infections [admission/nosocomial], and albumin use) were obtained at a time when terlipressin was not yet available.

The authors then predicted RF by performing multivariable regression using only admission day and in-hospital events occurring before RF.

In total, 511 patients (median age 57 years; admission model for end-stage liver disease [MELD]-Na 23) from 14 sites were included in the analysis. Of these, 15 percent developed RF, 24 percent had AKI, and 11 percent experienced nosocomial infections.

RF development was prevalent in patient who had higher MELD-Na, GI bleeding/AKI-related admission, and prior infection or ascites at admission. Those who developed RF had higher nosocomial infections (ie, respiratory), albumin use, and other organ failures during hospitalization.

RF occurred more often in patients receiving albumin (83 percent vs 59 percent; p<0.0001) with increasing doses (269.5 vs 208.6 g; p=0.01) irrespective of indication. RF development was associated with admission for AKI, GI bleeding, and high MELD-Na.

When using all variables, the following factors were found to predict RF risk: nosocomial infection (odds ratio [OR], 3.1; p=0.002), albumin use (OR, 2.93, p=0.01), AKI (OR, 3.26; p=0.008), and circulatory failure (OR, 3.73; p=0.002).

“Careful volume monitoring and preventing nosocomial respiratory infections and renal or circulatory failures could reduce this risk,” the authors said.