Clinical features, management and outcome in patients admitted with liver cirrhosis to the ICU - A retrospective study

Abstract

Background: Hepatic cirrhosis is an important cause of morbidity and mortality in the intensive care unit (ICU). Objective: To determine the precipitating factors, presenting complaints, course of the disease and predictors of mortality in patients with liver cirrhosis admitted to the ICU. Methods: This retrospective study was conducted mat Multidisciplinary ICU at tertiary care hospital from April 2013 to March 2014. A total of 107 patients diagnosed with liver cirrhosis were admitted to the ICU. Of these, 17 were discharged against medical advice. The remaining 90 patients were included in the study. Their case notes were examined for data such as severity of disease, precipitating events and their course in the ICU. The survivors were followed up telephonically to assess survival at six months. Results: There were 30 survivors and 60 nonsurvivors. The stage of cirrhosis (based on modified Child-Pugh criteria) had significant association with hospital mortality and disease outcome. Mortality was significantly higher in patients presenting with sepsis and septic shock (P=0.022) and hepatic encephalopathy (P=0.007). Interventions such as mechanical ventilatory support (P=0.002), inotropes (P=0.001) and vasopressors (P=0.048), variceal banding (P=0.005), need for transfusion of fresh frozen plasma (P=0.001) and packed cell transfusion (P=0.036) showed significant association with clinical outcome. Conclusion: Overall mortality rate of patients admitted in the ICU with liver cirrhosis is high (66.7%). Mortality rate is higher in those with Stage C cirrhosis, sepsis and septic shock and hepatic failure. Among the patients who survive, one third may not survive beyond six months after hospital discharge.