Moderate hyperkalemia in hospitalized patients with cirrhotic ascites indicates a poor prognosis

Abstract

Objective. Development of ascites in patients with liver cirrhosis is an ominous sign with a poor outcome. A liver transplantation must be considered, and it then becomes important to know if there are any factors indicating a worsened prognosis. Material and methods. We used official registers for a follow-up study of at least 5 years considering the prognosis of 155 prospectively recruited in-patients with cirrhotic ascites from medical units at nine Swedish university hospitals. All patients had undergone at least one diagnostic ascites tap, and had initially been questioned about background factors and physically examined according to a standardized case record form, followed by sampling of blood, urine, and ascites. Results. Death occurred within 1 year after inclusion in 53% of the cases, and was primarily liver-related in 70%. In a multivariable analysis, the two ordinary variables that showed the strongest correlation with risk of death were serum potassium and abdominal tenderness. All 22 patients with a serum potassium concentration of at least 4.8 mmol/L (maximum 5.8 mmol/L) died within 1 year after inclusion. Potassium concentration was related to renal function and potassium-saving drugs. Conclusion. This follow-up study of a prospectively recruited cohort of in-patients with cirrhotic ascites confirms their poor prognosis. Awareness of an elevated serum potassium value, which would reflect a threatened renal function, seems essential, because it may offer a simple way to identify cases with the worst prognosis. An area for further research should be to explore the significance of including serum potassium in prognostic models.

Key Words::

• ascites
• cirrhosis
• potassium
• prognosis
• signs

Acknowledgments

The study, which was supported financially by faculty grants, was initiated as a collaboration project within SILK, the Swedish Internal Medicine Liver Club, which is supported by Meda. We are deeply grateful to our coworkers and colleagues, Rolf Olsson, and Ulrika Broomé, whose deaths prevented their final contributions to our report. We also thank Annika Bergquist, Åke Danielsson, Hans Glaumann, Stefan Lindgren, Per Sangfelt, Per Stål, Hans Verbaan, and Mårten Werner, all members of the SILK group, who were participating investigators and served as scientific advisors.

Declaration of interest : The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the paper.