A population-based cohort study of mortality of intensive care unit patients with liver cirrhosis

Yu-Feng Huang,Chun-Chieh Yeh,Ray-Jade Chen,Chao-Shun Lin,Chien-Chang Liao,Ta-Liang Chen,Yih-Giun Cherng

doi:10.1186/s12876-020-1163-1

Abstract

BackgroundThe impact of liver cirrhosis on the outcomes of admission to intensive care unit (ICU) is not completely understood. Our purpose is to identify risk factors for mortality in ICU patients with liver cirrhosis.MethodsUsing reimbursement claims from Taiwan’s National Health Insurance Research Database from in 2006–2012, 1,250,300 patients were identified as having ICU stays of more than 1 day, and 37,197 of these had liver cirrhosis. With propensity score-matching for socioeconomic status, pre-existing medical conditions, and cirrhosis-related morbidities, 37,197 ICU patients without liver cirrhosis were selected for comparison. Adjusted odds ratios (ORs) and 95% confidence intervals (CIs) of cirrhosis associated with 30-day, ICU, and one-year mortality were calculated.ResultsCompared with control, cirrhotic patients had higher 30-day mortality (aOR 1.60, 95% CI 1.53 to 1.68), particularly those with jaundice (aOR 2.23, 95% CI 2.03 to 2.45), ascites (aOR 2.32, 95% CI 2.19 to 2.46) or hepatic coma (aOR 2.21, 95% CI 2.07 to 2.36). Among ICU patients, liver cirrhosis was also associated with ICU mortality (aOR 144, 95% CI 1.38 to 1.51) and one-year mortality (aOR 1.40, 95% CI 1.35 to 1.46). Associations between cirrhosis of liver and increased 30-day mortality were significant in both sexes and every age group.ConclusionsLiver cirrhosis was associated with 30-day mortality in ICU patients. Jaundice, ascites, hepatic coma, more than 4 admissions due to cirrhosis, and more than 30 days of hospital stay due to cirrhosis were exacerbated factors in cirrhotic ICU patients.

Highlights

The impact of liver cirrhosis on the outcomes of admission to intensive care unit (ICU) is not completely understood
We evaluated the impacts of different comorbidities and cirrhosis-related clinical indictors on ICU mortality and on one-year survival in further stratified analyses
We investigated the impact of liver cirrhosis on 30-day mortality, ICU mortality, and one-year mortality among ICU patients in this study

Summary

Introduction

The impact of liver cirrhosis on the outcomes of admission to intensive care unit (ICU) is not completely understood. Our purpose is to identify risk factors for mortality in ICU patients with liver cirrhosis. Cirrhosis of the liver results in various complications and mortality worldwide, but especially in developed regions [1]. It is the fourth most common cause of death in Europe and leads to more than a million deaths around the globe annually [2, 3]. Patients in late-stage liver cirrhosis are likely to be admitted to ICUs for critical conditions such as sepsis and renal or respiratory failure [4, 5]. Though some studies reported improving outcomes in patients with cirrhosis admitted to ICUs [6], the prognosis remains poor, with mortality rates as high as 45% or even higher [7, 8]

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