Incidence and Outcomes for Patients With Cirrhosis Admitted to the United Kingdom Critical Care Units*

McPhail, Mark; Parrott, Francesca; Wendon, Julia; Harrison, David A; Rowan, Kathy; Bernal, William

doi:10.1097/ccm.0000000000002961

Cited by 52 publications

(51 citation statements)

References 30 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The observed hospital mortality of 37% in this series is comparable to recent findings from overseas and the ANZICS APD registry analysis of cirrhotic patients, justifying the proposition for improved access to intensive care for these patients . The majority of data currently are from single‐centre and larger registry trials in both the United States and the United Kingdom which include specialist liver and liver transplant centres which may bias results . While we recognise the external validity of large registry studies, their primary intention of data collection is for quality surveillance and hence standardised data entry across all centres cannot be ascertained for accuracy including any absent specific data for a clinical question proposed following data collection.…”

Section: Discussionsupporting

confidence: 57%

“…A 2017 meta‐analysis on 13 eligible studies over a 10‐year period, on the prognosis of 2523 cirrhotic patients admitted to ICU did not find a difference in outcome with alcohol‐induced cirrhosis. In contrast, Kings College data suggested an increased ROD, with OR 1.51 (95% CI: 1.42–1.62, P < 0.001), in alcohol‐related liver disease in over 31 000 patients. The disparity potentially may stem from the greater number of acute alcoholic hepatitis patients in the Kings College data which would be associated with concomitant alcohol use.…”

Section: Discussionmentioning

confidence: 84%

“…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%

“…More recently, literature from the United States and the United Kingdom has challenged the previously accepted bleak outcomes for patients with cirrhosis and organ failure reporting mortality rates of 39–54% . The Kings College group conducted a national retrospective clinical audit in ICU within England, Wales and Northern Ireland . In the analysis of 31 363 patients between 1998 and 2012, there was a reported 10% reduction (41–31%) in ICU mortality and 12% reduction (58–46%) in‐hospital mortality over a 14‐year period in those with decompensated cirrhosis presenting to ICU, despite no significant change in the acuity of patients admitted.…”

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

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

View full text Add to dashboard Cite

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.

show abstract

Section: Discussionsupporting

confidence: 57%

Section: Discussionmentioning

confidence: 84%

Section: Discussionmentioning

confidence: 92%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

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

View full text Add to dashboard Cite

show abstract

“…As a consequence, severely ill patients with end-stage liver disease (ESLD), prioritized for LT, have been increasingly admitted to the intensive care unit (ICU). 4 Outcomes of patients with ESLD in the ICU used to concern intensivists due to their outcomes compared to the general population. 5,6 However, improved practices have led to an outstanding 30 point short-term survival gain between 2000 and 2010 in a liver-specific ICU.…”

Section: Introductionmentioning

confidence: 99%

Approaches for patients with very high MELD scores

Artru

Samuel

2019

JHEP Reports

View full text Add to dashboard Cite

In the era of the "sickest first" policy, patients with very high model for end-stage liver disease (MELD) scores have been increasingly admitted to the intensive care unit with the expectation that they will receive a liver transplant (LT) in the absence of improvement on supportive therapies. Such patients are often admitted in a context of acute-on-chronic liver failure with extrahepatic failures. Sequential assessment of scores or classification based on organ failures within the first days after admission help to stratify the risk of mortality in this population. Although the prognosis of severely ill cirrhotic patients has recently improved, transplant-free mortality remains high. LT is still the only curative treatment in this population. Yet, the increased relative scarcity of graft resource must be considered alongside the increased risk of losing a graft in the initial postoperative period when performing LT in "too sick to transplant" patients. Variables associated with poor immediate post-LT outcomes have been identified in large studies. Despite this, the performance of scores based on these variables is still insufficient. Consideration of a patient's comorbidities and frailty is an appealing predictive approach in this population that has proven of great value in many other diseases. So far, local expertise remains the last safeguard to LT. Using this expertise, data are accumulating on favourable post-LT outcomes in very high MELD populations, particularly when LT is performed in a situation of stabilization/improvement of organ failures in selected candidates. The absence of "definitive" contraindications and the control of "dynamic" contraindications allow a "transplantation window" to be defined. This window must be identified swiftly after admission given the poor short-term survival of patients with very high MELD scores. In the absence of any prospect of LT, withdrawal of care could be discussed to ensure respect of patient life, dignity and wishes.

show abstract

Liver Injury and Failure in Critical Illness

et al. 2019

View full text Add to dashboard Cite

The frequency of acquired liver injury and failure in critical illness has been significantly increasing over recent decades. Currently, liver injury and failure are observed in up to 20% of patients in intensive care units and are associated with significantly increased morbidity and mortality. Secondary forms of liver injury in critical illness are divided primarily into cholestatic, hypoxic, or mixed forms. Therefore, sufficient knowledge of underlying alterations (e.g., hemodynamic, inflammatory, or drug induced) is key to a better understanding of clinical manifestations, prognostic implications, as well as diagnostic and therapeutic options of acquired liver injury and failure. This review provides a structured approach for the evaluation and treatment of acquired liver injury and failure in critically ill patients.

show abstract

Incidence and Outcomes for Patients With Cirrhosis Admitted to the United Kingdom Critical Care Units*

Cited by 52 publications

References 30 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

Approaches for patients with very high MELD scores

Liver Injury and Failure in Critical Illness

Contact Info

Product

Resources

About