PREEXISTING CHRONIC LIVER DISEASE AS AN INDEPENDENT RISK FACTOR REINTUBATION IN MECHANICALLY VENTILATED PATIENTS

Abstract

SESSION TITLE: Critical Care Posters SESSION TYPE: Original Investigation Posters PRESENTED ON: October 18-21, 2020 PURPOSE: Hepatic functional status is not routinely considered a risk factor for ventilation liberation failure. We wanted to evaluate the impact of chronic liver disease (CLD) on the risk of reintubation after mechanical ventilation for ≥ 24 hours. METHODS: We queried the Medical Information Mart for Intensive Care database (MIMIC-III) for adult patients admitted to intensive care and mechanically ventilated for ≥ 24 hours. Data for 8,521 patient was analyzed, 623 had existing CLD and 7898 had no underlying liver abnormality. Only the first intubation for the hospital stay was included, and patient who underwent tracheotomy or terminal extubation were excluded. We identified underlying liver disease using International Classification of Diseases, 9th revision and clinical modification (ICD-9-CM) codes, we compared the means using unpaired t-test, and carried out logistic regression analysis after adjustment for Charlson Comorbidity Index. RESULTS: The mean age of patents receiving mechanical ventilation (MV) without underlying chronic liver disease was 72.1 years 95% CI [71, 73.2], the mean age of patients with CLD receiving MV was 57.1 years, 95% CI [55.5, 58.7], p < 0.001. 54.5% patient were men in the non-CLD sample and 66.1% were men in the CLD sample. The mean duration of ventilation was 7.12 days, 95% CI [6.94, 7.3] in the non-CLD sample vs 6.83 days, 95% CI [6.29, 7.37] in the CLD sample, p = 0.40. The mean length of ICU stay for non-CLD patient was 10.42 days, 95% CI [10.2, 10.6] in comparison for CLD patients was 10.2 days, 95% CI [9.52, 10.9] p = 0.59. 25.1% died during their hospital stay in the non-CLD cohort vs. 37.8% in the CLD cohort, adjusted OR 1.82, 95 % CI [1.53, 2.15]. Of the 7898 non-CLD patients undergoing mechanical ventilation 1488 were reintubated within 72 hours (18.8%), of the 623 CLD patients undergoing mechanical ventilation 144 (23.1%) were reintubated within 72 hours, adjusted OR 1.3 95 % CI [1.06, 1.57], p = 0.009. CONCLUSIONS: Patient having underlying chronic liver disease undergoing mechanical ventilation were younger in age, and had a higher in hospital mortality compared to general population receiving mechanical ventilation without underlying liver disease. Patient with chronic liver disease were 1.3 times more likely to get reintubated within 72 hours of extubation compared to patients without underlying liver abnormality. The mean duration of ventilation and mean ICU length of stay was not significantly different in the two samples. CLINICAL IMPLICATIONS: Underlying chronic liver disease should be accounted as an independent risk factor for reintuabtion in mechanically ventilated patients. DISCLOSURES: No relevant relationships by Muhammad Sameed, source=Web Response No relevant relationships by Muhammad Waleed, source=Web Response No relevant relationships by Jennie Zhang, source=Web Response