Predictors of Mortality in Patients With Cirrhosis Admitted at Intensive Care Unit at Cardinal Santos Medical Center

Abstract

Cirrhotic patients who need critical care support show high morbidity and mortality rates compared with other critically ill patients. Their prognosis is, in fact, influenced by both the severity of the underlying hepatic disease and the worsening of extrahepatic organ function. Patients with cirrhosis are admitted to intensive care units (ICUs) for complications of portal hypertension such as variceal bleeding, hepatic encephalopathy or sepsis culminating in multiple organ failure in a large portion of patients. The objective of the study is to identify predictors of mortality in a retrospective analysis of patients with cirrhosis admitted to ICU of Cardinal Santos Medical Center and to compare these predictors to that established liver specific (Child-Pugh Score, Model for End-Stage Liver Disease (MELD) and MELD-Na) prognostic models. A total of 51 cirrhotic patients were admitted at the Cardinal Santos Medical Center Medical Intensive Care Unit between June 1, 2009 to June 30, 2015. The results are presented as means with ± standard deviations and confidence intervals of 95% for quantitative variables and as percentages for categorical variables. It was found that cirrhosis is more frequent in males and usually at their fifth and sixth decades of life and Hepatits B is the most common cause of cirrhosis. Although Child-Pugh score indicates the severity of underlying liver disease it cannot be considered as the best tool for predicting mortality in cirrhotic patients. Among patients admitted in the ICU, encephalopathy is a complication involving low survival. Among the clinical parameters, the use of mechanical ventilator, the need for inotropic support, the need for renal replacement therapy are associated with increased mortality rate. Among the laboratory parameters, lower venous pH and bicarbonate values in cirrhotic patients are significantly associated with mortality. The prognosis for cirrhotic patients admitted to the ICU is poor.