Key result
Physiological network deviations along the arterial pH-bicarbonate axis significantly predicted 28-day mortality independent of SOFA score and King's College Criteria (HR 1.32).
Why the study?
Prognostication in acute liver failure relies on models that do not consider organ system interactions, and clinical quantitative evidence for physiological network analysis is lacking.
Does physiological network analysis predict survival in critically ill patients with acute liver failure?
Cohort (n=640)
No
Does physiological network analysis predict survival in critically ill patients with acute liver failure?
Hazard Ratio: 1.32 (95% CI 1.11–1.56)
p-value: p=0.001
Physiological network analysis of routine biomarkers can provide pathophysiologic insight and independently predict 28-day survival in critically ill patients with acute liver failure.
May refine ALF prognostication via organ-interaction metrics; leaves open added value over existing models.
Reduced functional connectivity of physiological systems is associated with poor prognosis in critically ill patients. However, physiological network analysis is not commonly used in clinical practice and awaits quantitative evidence. Acute liver failure (ALF) is associated with multiorgan failure and mortality. Prognostication in ALF is highly important for clinical management but is currently dependent on models that do not consider the interaction between organ systems. This study aims to examine whether physiological network analysis can predict survival in patients with ALF. Data from 640 adult patients admitted to the ICU for paracetamol-induced ALF were extracted from the MIMIC-III database. Parenclitic network analysis was performed on the routine biomarkers using 28-day survivors as reference population and network clusters were identified for survivors and non-survivors using k-clique percolation method. Network analysis showed that liver function biomarkers were more clustered in survivors than in non-survivors. Arterial pH was also found to cluster with serum creatinine and bicarbonate in survivors compared with non-survivors, where it clustered with respiratory nodes indicating physiologically distinctive compensatory mechanism. Deviation along the pH-bicarbonate and pH-creatinine axes significantly predicts mortality independent of current prognostic indicators. These results demonstrate that network analysis can provide pathophysiologic insight and predict survival in critically ill patients with ALF.
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Oyelade et al. (2024) conducted a cohort in Paracetamol-induced acute liver failure (n=640). Parenclitic network deviations (e.g., pH-bicarbonate axis) vs. Lower network deviation was evaluated on 28-day ICU mortality or liver transplantation (HR 1.32, 95% CI 1.11-1.56, p=0.001). Physiological network deviations along the arterial pH-bicarbonate axis significantly predicted 28-day mortality independent of SOFA score and King's College Criteria (HR 1.32).
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