Relationship Between Etiology of Cirrhosis and Survival Among Patients Hospitalized in Intensive Care Units

Choi, Chansong; Choi, Dong‐Young; Spears, Grant M.; Peeraphatdit, Thoetchai; Serafim, Laura Piccolo; Gajic, Ognjen; Kamath, Patrick S.; Shah, Vijay H.; Moraes, Alice Gallo De; Simonetto, Douglas A.

doi:10.1016/j.mayocp.2021.08.025

Cited by 5 publications

(6 citation statements)

References 33 publications

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“…A total of 411 patients presented multiple admissions (28.8% of the investigated group). This result is much lower than the readmission rates reported by various researchers (50-78%), possibly due to the limitation of the patients' accessibility to medical services during the COVID-19 pandemic [19][20][21]. Hepatic encephalopathy (70.6%), ascites (48.6%), and variceal bleeding (32.1%) were the most common causes that led to hospitalization.…”

Section: Discussionmentioning

confidence: 68%

Predictive Factors for the Prognosis of Alcoholic Liver Cirrhosis

et al. 2022

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Alcoholic liver cirrhosis (ALC) is a disease with multiple complications and is associated with poor prognosis and significant mortality. Identifying risk factors associated with a poor outcome is important to ensure effective treatment and increase life expectancy. We aimed to evaluate the predictive values of complications regarding mortality in ALC. We retrospectively analyzed 1429 patients with ALC hospitalized between January 2019 and April 2022 at the Institute of Gastroenterology and Hepatology Iasi. The electronic medical records were interrogated to obtain information about demographic data, complications, comorbidities, and prognostic scores: MELD-Na (model for end-stage liver disease-sodium) and CTP (Child–Turcotte–Pugh). Based on uni- and multivariate analysis, independent predictors of mortality were identified. The mean age at diagnosis was 56.15 ± 11.49 years with a ratio of 2:1 in favor of males. There were 296 deaths (20.8%), most of them during the first hospitalization (208/14.6%). It was observed during the univariate analysis that complications of the disease negatively affected the survival rate, significant values being related to infections (sepsis; OR = 21.98; p < 0.001; spontaneous bacterial peritonitis (SBP) (OR = 11.94; p < 0.001) and hepatorenal syndrome (HRS) (OR = 9.35; p < 0.001). The independent predictors, confirmed by multivariate analysis, were the association of variceal bleeding, infections, and hepatic encephalopathy or ascites, each combination being responsible for two out of 10 of the deaths during the first admission. The prognosis of the disease was negatively influenced by the worsening of liver dysfunction and the appearance of complications. The main predictors of mortality were infections, hepatic encephalopathy, variceal bleeding, and hepatorenal syndrome. Improving compliance and strict application of specific follow-up and treatment strategies could contribute to a better prognosis of patients with alcoholic liver cirrhosis.

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Section: Discussionmentioning

confidence: 68%

Predictive Factors for the Prognosis of Alcoholic Liver Cirrhosis

et al. 2022

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“…22 However, other studies have found that the qSOFA score was unable to reliably predict infection, in-hospital mortality, or 30-day mortality. [23][24][25][26] Its performance was found to be inferior to CLIF-SOFA score in a retrospective, multicenter study. 27 The performance of liver-specific models is also lower, with MELD slightly outperforming Child-Pugh.…”

Section: Admissionmentioning

confidence: 92%

“…6 Multiple studies have found admissions for infection to be associated with higher ICU and hospital mortality. 26,29 Some studies have demonstrated that direct admission to the ICU is associated with better prognosis than initial admission to a hepatology unit. 16,30,31 However, not all decompensating events will require ICU monitoring and management, and some patients recover well while managed on the floor.…”

Section: Admissionmentioning

confidence: 99%

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Cirrhosis Management in the Intensive Care Unit

2023

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Patients with cirrhosis frequently require admission to the intensive care unit as complications arise in the course of their disease. These admissions are associated with high short- and long-term morbidity and mortality. Thus, understanding and characterizing complications and unique needs of patients with cirrhosis and acute-on-chronic liver failure helps providers identify appropriate level of care and evidence-based treatments. While there is no widely accepted critical care admission criteria for patients with cirrhosis, the presence of organ failure and primary or nosocomial infections are associated with particularly high in-hospital mortality. Optimal management of patients with cirrhosis in the critical care setting requires a system-based approach that acknowledges deviations from canonical pathophysiology. In this review we discuss appropriate considerations and evidence-based practices for the general care of patients with cirrhosis and critical illness.

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“…Alcohol abstinence is the primary treatment strategy for alcohol-related liver cirrhosis and may lead to a shift from decompensated to compensated stage. Cirrhotic patients are advised to abstain from alcohol and smoking, irrespective of etiologies [5,6]. With the improvement of lifestyle, nonalcoholic fatty liver disease (NAFLD), also named metabolic dysfunction-associated fatty liver disease (MAFLD), affects approximately 30% of the global population and has become the predominant cause of liver diseases worldwide.…”

Section: Introductionmentioning

confidence: 99%

Management of liver cirrhosis and its complications

Wu,

Chen,

Chen

et al. 2024

Liver Cirrhosis and Its Complications - Advances in Diagnosis and Management

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Liver cirrhosis is a widespread global health concern with various potential causes, such as chronic viral hepatitis, nonalcoholic fatty liver disease, alcohol consumption, and autoimmune diseases. The development of cirrhosis occurs over an extended period of chronic inflammation, leading to the substitution of healthy liver tissue with fibrotic tissue and regenerative nodules, ultimately leading to the onset of portal hypertension. Decompensated cirrhosis, which arises from a compensated stage, is characterized by the emergence of complications such as ascites, esophageal variceal bleeding, hepatorenal syndrome, hepatic encephalopathy, portal vein thrombosis, and hepatocellular carcinoma, which will result in prolonged hospitalization, impaired quality of life, and poor survival. In recent years, a concept known as “cirrhosis recompensation” has gained prominence in the field of liver cirrhosis. Cirrhosis recompensation, as defined by the Baveno VII consensus criteria, involves three core elements: addressing the underlying etiological factors, achieving remission from complications that are characteristic of the decompensated stage of cirrhosis, and achieving improvements in liver function. Consequently, the management of cirrhosis focuses on the elimination of underlying etiologies, surveillance for hepatocellular carcinoma and esophageal varices, assessment of suitability for liver transplantation, and treatment of complications.

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Relationship Between Etiology of Cirrhosis and Survival Among Patients Hospitalized in Intensive Care Units

Cited by 5 publications

References 33 publications

Predictive Factors for the Prognosis of Alcoholic Liver Cirrhosis

Predictive Factors for the Prognosis of Alcoholic Liver Cirrhosis

Cirrhosis Management in the Intensive Care Unit

Management of liver cirrhosis and its complications

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