Intensive Care Need and Its Predictors Among Patients Admitted With Acute on Chronic Liver Failure: A Retrospective Study From a Single Tertiary Care Center

Abstract

Introduction: Acute-on-chronic liver failure (ACLF) among patients with chronic liver disease has high mortality secondary to organ failure (OF). Data on need for ICU care in ACLF patients are scanty. Methods: Medical charts were reviewed on patients admitted to a tertiary care center with discharge diagnosis of cirrhosis to analyze ACLF patients (based on organ failures Gastroenterology 2013; 144: 1426-37) for ICU care and its predictors. ICU transfer was initiated based on criteria as for any other patient on medical floor or emergency room. Results: Of 567 patients discharged with cirrhosis diagnosis between 7/1/16 and 6/30/17, 123 (22%) met criteria for ACLF diagnosis (mean age 55yrs., 50% males, 79% white, 54% alcoholic cirrhosis, 80% with prior decompensation, mean MELD score 27, mean white cell count 10.6/cmm), precipitated by alcoholic hepatitis (33%), infection (31%), GI bleed (15%), and unknown in 20%. Coagulation failure (INR>2.5) was most common in 91 (74%) followed by renal (creatinine >2 mg/dL or dialysis) in 80 (65%), brain (grade III-IV encephalopathy) in 64 (52%), liver (bilirubin> 12 mg/dL) in 60 (49%), lung (mechanical ventilation) in 42 (34%), and heart (use of pressor) in 40 (33%). Of 123 ACLF patients, 66 (54%) needed ICU care. Of these, 50 were ACLF grade 3, 12 grade 2, and 4 grade 1 (p= Conclusion: ICU care is frequently needed among ACLF patients, with higher inpatient mortality and use of hospital resources. Studies are needed to develop criteria for early ICU transfer among ACLF patients, as basis for improving outcomes of patients with ACLF.