Abstract
ObjectivesThe 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.DesignObservational cohort study.SettingGeneral adult critical care unit in a UK teaching hospital.PatientsEighty-four patients admitted to critical care between June 2012 and December 2013.Primary outcome measuresCumulative survival at ICU discharge, hospital discharge and 12 months.ResultsEighty-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%.ConclusionsPatients 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.
Highlights
Liver disease is the third most common cause of premature death in the United Kingdom (UK) [1], and patients with liver cirrhosis comprise between 2.6 and 15% of admissions to intensive care units (ICUs) in the UK [2,3,4,5]
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
Summary
Liver disease is the third most common cause of premature death in the United Kingdom (UK) [1], and patients with liver cirrhosis comprise between 2.6 and 15% of admissions to intensive care units (ICUs) in the UK [2,3,4,5] Though survival in this patient group has historically been very poor, with reported hospital mortality as high as 89% [6,7,8], it has recently demonstrated that shortterm survival is improving [9,10,11]. The most widely used method for assessing patients with chronic liver disease is the Child–Pugh score; this has been found to poorly predict short-term outcome in cirrhotic patients admitted to ICU [5, 11, 12, 19,20,21]. Child–Pugh + Lactate was found to be the best performing score at predicting ICU mortality in a previous study from this centre [5]
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