Alcoholic liver disease on the intensive care unit – Outcomes and prognostication

Beck, James I; Staicu, Anca; Everett, Simon; Jackson, Philippa

doi:10.1177/1751143716662055

Cited by 4 publications

(5 citation statements)

References 8 publications

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“…26 Physiological based scoring systems have a greater discriminatory capacity to predict outcome compared to liver-specific scores in patients with DLD. 13,14,22,27 SOFA performed the best with area under the curve (AUC) values of 0.86 in this study, comparative to other studies which calculated an AUC >0.90. 7,13,28 SOFA outperformed MELD-Na (AUROC: 0.71) in this study which has demonstrated previously to be the most useful of the liver-specific scores for this patient group.…”

Section: Discussionmentioning

confidence: 40%

“…Physiological based scoring systems have a greater discriminatory capacity to predict outcome compared to liver‐specific scores in patients with DLD . SOFA performed the best with area under the curve (AUC) values of 0.86 in this study, comparative to other studies which calculated an AUC >0.90 .…”

Section: Discussionmentioning

confidence: 59%

“…These results emphasise that the presenting diagnosis should not be the only factor evaluated when considering ICU admission, but should guide clinical acumen in the necessity for earlier intervention and organ support. 12,22 Our data revealed that mortality was greater with increasing organ support with mechanical ventilation, vasopressor support and/or renal replacement therapy. Reported mortality in the literature with single system support was 4% and up to 80-100% hospital mortality for three system failures.…”

Section: Discussionmentioning

confidence: 80%

“…Non‐SBP infections are often difficult to diagnose and hence there are delays initiating appropriate antimicrobial therapy. These results emphasise that the presenting diagnosis should not be the only factor evaluated when considering ICU admission, but should guide clinical acumen in the necessity for earlier intervention and organ support …”

Section: Discussionmentioning

confidence: 92%

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Survival and predictors of outcome among patients with decompensated liver disease in a non‐liver transplant intensive care unit. Pessimism is historical and unjustified

Sadick

Bowcock

Lane

et al. 2019

Internal Medicine Journal

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Background Recent literature emanating from the United Kingdom and United States has reported decreasing mortality rates in patients with decompensated cirrhosis and organ failures presenting to the intensive care unit (ICU). Aim To determine if there were comparable outcomes in a single‐centre non‐transplant unit in Australia. Methods A retrospective observational study was conducted in a tertiary, non‐liver transplant unit in Sydney, Australia. Admission data and mortality outcomes were collected from patients with cirrhosis non‐electively admitted to ICU between 2013 and 2017. Liver‐specific and general intensive care scoring tools were also assessed for their discriminative ability to predict short‐term prognostic outcomes. Results Sixty‐three patients were admitted with decompensated liver disease who fulfilled the inclusion criteria. The overall hospital mortality was 37% (95% CI: 0.26–0.49). There was no difference in survival based on aetiology of liver disease (P = 0.96) but a significant difference was found based on the presenting diagnosis, with greater survival among patients diagnosed with hepatic encephalopathy on ICU admission (P = 0.02). There was 4% mortality in patients with no organ failure and 52% mortality in those with ≥3 organs in failure (P < 0.001). The ICU prognostic Sequential Organ Failure Assessment score was the better discriminative tool in predicting short‐term outcomes when compared to liver prognostic scores. Conclusion The outcomes of this single‐centre Australian study align with current overseas literature. These results reinforce and expand on limited local evidence, corroborating the former universal prognostic pessimism towards cirrhotic patients with organ failure as unwarranted.

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Section: Discussionmentioning

confidence: 40%

Section: Discussionmentioning

confidence: 59%

Section: Discussionmentioning

confidence: 80%

Section: Discussionmentioning

confidence: 92%

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Survival and predictors of outcome among patients with decompensated liver disease in a non‐liver transplant intensive care unit. Pessimism is historical and unjustified

Sadick

Bowcock

Lane

et al. 2019

Internal Medicine Journal

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“…Christensen et al reported that up to 7.3% of patients entering ICUs in Denmark were alcoholics [16]. It should be noted that only 25% of these patients were defined as having “complicated” alcohol dependency syndrome [17].…”

Section: Discussionmentioning

confidence: 99%

Young Adults Among Patients Admitted to Polish Intensive Care Units in the Silesian ICU Registry

et al. 2019

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Background Patients under 30 years of age constitute a unique population in the Intensive Care Unit (ICU). The aim of this study was to obtain information on young adults admitted to Polish ICUs and to identify independent predictors of favorable outcome in this population. Material/Methods Data from 20 651 adult patients from the Silesian Registry of Intensive Care Units conducted in the Silesian Region of Poland since October 2010 were analyzed. Patients aged 18–29 years were identified and their data were compared to the remaining population. Preadmission and admission variables that independently influence the favorable outcome (defined as survival of ICU stay and discharge in a condition other than vegetative state or minimally conscious state) were identified. Results Among 20 609 analyzed adult patients, 850 (4.1%) were under the age of 30 years. Young adults had a lower mean APACHE II and SAPS III score at admission and were more frequently admitted to the ICU due to trauma, poisonings, acute neurological disorders, and obstetric complications. ICU mortality was over 2 times lower (20.1% vs. 45.3%, p<0.001). Independent variables affecting favorable outcome in this population were: admission to ICU from the operating theatre and multiple trauma as a primary cause of admission. Conclusions The greater chance of favorable outcome in adults under the age of 30 years admitted to the ICU is due to their unique characteristics. Favorable outcome in young adults is most likely among patients admitted to the ICU following multiple trauma or admitted from the operating theatre.

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Caring for the Critically Ill Alcoholic Liver Disease Patient: An Uphill Battle Worth Fighting*

Flynn

Subramanian

2019

Critical Care Medicine

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Alcoholic liver disease on the intensive care unit – Outcomes and prognostication

Cited by 4 publications

References 8 publications

Survival and predictors of outcome among patients with decompensated liver disease in a non‐liver transplant intensive care unit. Pessimism is historical and unjustified

Survival and predictors of outcome among patients with decompensated liver disease in a non‐liver transplant intensive care unit. Pessimism is historical and unjustified

Young Adults Among Patients Admitted to Polish Intensive Care Units in the Silesian ICU Registry

Caring for the Critically Ill Alcoholic Liver Disease Patient: An Uphill Battle Worth Fighting*

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