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Letters to the editor
Renal and brain failure predict mortality of patients with acute-on-chronic liver failure admitted to the intensive care unit
Shishi Ying
Emergecy Department, YiWu Central Hospital, Zhejiang 322000, China
Xiaofei Li
Corresponding author
icqwc46@163.com

Corresponding author.
Department of Infectious Diseases, YiWu Central Hospital, Zhejiang 322000, China
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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">We read with great interest the article by Guerrero et al&#46; &#91;<a class="elsevierStyleCrossRef" href="#bib0005">1</a>&#93; mainly explored the important risk factors of mortality in patients with acute on chronic liver failure &#40;ACLF&#41; admitted to the intensive care unit&#46; The results of this retrospective cohort study revealed that renal and brain failure could be used to predict 28-day and 90-day mortality&#46; The results of this study are attention-grabbing&#44; but we would like to point out the following issues&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">First of all&#44; it should be emphasized that obesity is a disease characterized by chronic low-grade inflammatory &#91;<a class="elsevierStyleCrossRefs" href="#bib0010">2&#8211;4</a>&#93;&#44; which has been confirmed as a risk factor for numerous diseases&#44; including ACLF &#91;<a class="elsevierStyleCrossRef" href="#bib0025">5</a>&#93;&#46; A study based on the United Network for Organ Sharing &#40;UNOS&#41; database involving 387&#44;884 participants exhibited that obese patients had a higher incidence of adverse events than non-obese patients &#91;<a class="elsevierStyleCrossRef" href="#bib0025">5</a>&#93;&#46; More interestingly&#44; the conclusions of this study also demonstrated that obese ACLF patients had a higher incidence of renal failure that non-obese ACLF patients &#91;<a class="elsevierStyleCrossRef" href="#bib0025">5</a>&#93;&#46; However&#44; obesity&#44; as a crucial indicator commonly used in clinical practice&#44; was not described in this study&#44; which might be a limitation that cannot be ignored&#46; Since there is a significant association between obesity and renal failure and prognosis in ACLF patients&#44; how to confirm that renal failure is independently related to prognosis of CLF patients without controlling the confounding factor of obesity&#63; In our opinion&#44; it is essential to describe the body mass index &#40;BMI&#41; of the two groups &#40;died or survived&#41; and then adjust BMI as a confounding factor in Cox regression analysis&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">Second&#44; the use of vasopressor&#44; mechanical ventilation and glucocorticoid are important treatment strategies for ICU patients in clinical practice&#44; which are associated with mortality &#91;<a class="elsevierStyleCrossRefs" href="#bib0030">6&#8211;8</a>&#93;&#46; However&#44; although vasopressin and mechanical ventilation were described &#40;Table 1&#41; in this study and glucocorticoids were not described&#44; none of these factors were included in bivariate and multivariate cox regression analysis&#44; which is a little confusing&#46; Obviously&#44; grade 3 patients had a higher rate of vasopressin use that grade 1&#47;2 patients &#40;97&#46;6&#37; versus 75&#46;6&#37;&#47; 48&#37;&#44; p &#61; 0&#46;001&#41; &#40;Table 1&#41;&#46; Therefore&#44; we think it would be better to describe why vasopressor use was not included in the subsequent multivariate regression analysis&#46; Additionally&#44; considering that mechanical ventilation also has an impact on mortality in clinical practice &#91;<a class="elsevierStyleCrossRef" href="#bib0045">9</a>&#44;<a class="elsevierStyleCrossRef" href="#bib0050">10</a>&#93;&#44; although there is no significant difference between groups&#44; we believe that mechanical ventilation should also be included in the regression analysis in order to obtain more accurate results&#46;</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Declaration of funding interests</span><p id="par0020" class="elsevierStylePara elsevierViewall">None&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Conflict of interest</span><p id="par0025" class="elsevierStylePara elsevierViewall">The authors have no conflict of interest to declare&#46;</p></span></span>"
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Article information
ISSN: 16652681
Original language: English
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es en pt

¿Es usted profesional sanitario apto para prescribir o dispensar medicamentos?

Are you a health professional able to prescribe or dispense drugs?

Você é um profissional de saúde habilitado a prescrever ou dispensar medicamentos