Long-term outcome of patients with liver cirrhosis admitted to a general intensive care unit (original) (raw)

Warren, Alex, Soulsby, Charlotte R., Puxty, Alex, Campbell, Joseph, Shaw, Martin, Quasim, Tara ORCID: https://orcid.org/0000-0002-9872-3623, Kinsella, John and McPeake, Joanne ORCID: https://orcid.org/0000-0001-8206-6801(2017) Long-term outcome of patients with liver cirrhosis admitted to a general intensive care unit.Annals of Intensive Care, 7, 37. (doi: 10.1186/s13613-017-0257-6) (PMID:28374334)

Abstract

Objectives: The prevalence of liver cirrhosis is increasing, and many patients have acute conditions requiring consideration of intensive care. This study aims to: (a) report the outcome at 12 months of patients with cirrhosis admitted to ICU, (b) identify factors predictive of long-term mortality and (c) evaluate the ability of scoring systems to predict long-term outcome. Design: Observational cohort study. Setting: General adult critical care unit in a UK teaching hospital. Patients: Eighty-four patients admitted to critical care between June 2012 and December 2013. Primary outcome measures: Cumulative survival at ICU discharge, hospital discharge and 12 months. Results: Eighty-four patients with diagnosed cirrhosis were followed up at 12 months. Clinical variables collected at ICU admission were entered into a multivariate regression analysis for mortality and eight predetermined scoring systems calculated. Cumulative survival at ICU discharge, hospital discharge and 12 months was 64.8, 47.1 and 44.1%, respectively. Twelve months of cumulative survival in patients with Child–Pugh class A was 100%, class B was 50% and class C was 25% (log rank p = 0.002). Independent predictors of mortality at 12 months were lactate, bilirubin, PT ratio and age. The Child–Pugh + Lactate score was modified to produce an objective score comprising Albumin, Bilirubin and Clotting (PT ratio) added to serum lactate concentration in mmol L−1 (ABC + Lactate). This score was the best predictor of 12-month survival, with an AUC of 0.83. A proposed classification by ABC + Lactate score was highly significant (p = 0.001), with those in the highest class having ICU mortality of 75% and hospital and 12-month mortality of 93%. Conclusions: Patients with cirrhosis admitted to ICU have high initial mortality but low mortality after hospital discharge. Child–Pugh class at ICU admission predicts outcome at 12 months. The ABC + Lactate classification system may be useful in identifying critically ill cirrhotic patients with very high long-term mortality.

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