Outcome of patients with cirrhosis requiring intensive care unit support: Prospective assessment of predictors of mortality

Abstract

Determinants of outcome and the utility of the Child-Pugh score and the acute physiology and chronic health evaluation (APACHE) II score as predictors of outcome were prospectively assessed in 54 consecutive patients with cirrhosis requiring intensive care unit (ICU) management. Overall mortality in the ICU was 43% (23/54). Child-Pugh scores did not differ between survivors or nonsurvivors (12.8 versus 12.3, P = 0.26), however APACHE II scores (P = 0.007), acute physiology scores (P = 0.006), and Karnofsky scores (P = 0.001) were significant predictors of outcome. By univariate analysis, requirement of mechanical ventilation analysis (P = 0.001), duration of mechanical ventilation (P = 0.001), pulmonary infiltrates (P = 0.0001), infections (P = 0.047), gastrointestinal bleeding (P = 0.005), and serum creatinine >1.5mg/dl (P = 0.0005) were significantly associated with mortality. By logistic regression analysis only pulmonary infiltrates (P = 0.0001) and renal dysfunction (P = 0.041) were independent predictors of mortality. When controlled for the severity of illness (APACHE II scores), the mortality in patients with cirrhosis caused by alcohol was significantly lower than that in patients with liver disease not caused by alcohol (P = 0.01). Our study not only identified predictors of poor outcome in patients with cirrhosis requiring ICU care but also provided data that may have implications for optimal timing for transplantation.

Predictors of Intra-Hospital Mortality in Patients with Cirrhosis

“…Several parameters were associated with intra-hospital mortality in cirrhotic patients, the most important being the degree of liver failure, since the bilirubin and prothrombin time were associated with a greater risk of mortality in several studies [30]. In our study, a prothrombin time < 45%, serum bilirubin > 50 mg/l, and serum albumin < 28 g/l were significantly associated with mortality , confirming the data of literature.…”

Prognostic scores in cirrhotic patients admitted to a gastroenterology intensive care unit

“…This is particularly relevant in cirrhotic patients, owing to the exponential increase in the incidence of this condition and the limited ICU resources (7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19) Our study assessed, to our knowledge for the first time, the accuracy of prognostic scores in cirrhotic patients admitted to a GICU. In our series, all the tested scores displayed good discrimination and calibration.…”

“…These results were somewhat expected if we take into account the characteristics of the cirrhotic patients admitted to ICUs and the structure of the different scores. Regarding the characteristics of the cirrhotics admitted to ICUs, these patients often have extrahepatic organ dysfunction and die of multiple organ failure (12)(13)(14)(34)(35)(36)(37)(38)(39). Concerning the structure of the prognostic models, the general scores include a global assessment of the patient's clinical condition, evaluating parameters related to the various organ systems (20)(21)(22)(23).…”

“…The incidence of liver cirrhosis is increasing exponentially and cirrhotic patients admitted to ICUs have high mortality rates and a high rate of consumption of resources (7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18). Furthermore, a significant percentage (36.7%) of the total cost of ICU care for cirrhotic patients is spent on those who do not survive (11,16,19).…”

“…These results are somewhat unsurprising if we bear in mind that the prognosis of acutely ill patients with cirrhosis is influenced not only by the severity of hepatic insufficiency but mainly by the dysfunction of other organ systems and that cirrhotics admitted to ICUs often have extrahepatic organ dysfunction and die of multiple organ failure (12)(13)(14)(34)(35)(36)(37)(38)(39).…”