Mortalité et facteurs pronostiques des patients cirrhotiques en encéphalopathie hépatique admis en réanimation

Abstract

Objective To assess mortality and to identify variables that could predict it in cirrhotic patients hospitalized to the medical intensive care unit (MICU) for hepatic encephalopathy (HE). Study design Retrospective cohort study. Patients and methods From January 1995 to December 2004, the cirrhotic patients admitted consecutively in MICU were screened and those with altered level of consciousness were included. The MICU mortality rate was assessed. Nearly 80 variables were analyzed and compared between survivors and non-survivors. Statistical analysis: t test, χ 2 or Fisher exact tests, Kaplan-Meier and log rank, Cox regression analysis. Results A total of 180 patients (42 women - 138 men, mean age: 59 ± 10 years) were admitted (incidence: 2.6%). The SAPS II was 30.1 ± 11, Acute Physiology Age and Chronic Health Evaluation II (APACHE II): 16.5 ± 5.3, Child-Pugh score: 9.1 ± 1.9 and GCS: 11 ± 2.8. The causes of liver cirrhosis was identified in 41.2% of cases (viral: 35.6%, alcohol: 5.6%). Nearly 18% of patients had an antecedent of HE. The causes of HE were: infection (65.6%), upper gastrointestinal bleeding (32.2%), drugs (5%) and metabolic cause (5%). MICU mortality rate was 33.3% and seemed higher in gastrointestinal bleeding. Eighteen variables were significantly associated with poor prognosis in univariate analysis. Only three variables remained significant in multivariate analysis: systolic blood pressure < 90 mmHg (RR = 4; IC95% = 2–8.1), total WBC > 12 000 n/mm 3 (RR = 3.1; IC95% = 1.8–5.3) and use of mechanical ventilation (RR = 3.1; IC95% = 1.7–5.6). Conclusion The MICU mortality of cirrhotic patients with HE was high and significantly associated with haemodynamic instability, hyperleucocytosis and mechanical ventilation.