WITHDRAWN: The Effects of Cirrhosis on Trauma Outcomes: An Analysis of the National Trauma Data Bank

Abstract

Introduction A number of small retrospective studies have shown that cirrhosis is associated with increased mortality and poor outcomes in trauma. While these studies have provided useful insight into the management of this unique group of patients, their clinical utility has been limited by very small sample size. The purpose of this study was to examine the relationship between cirrhosis and clinical outcomes using a much larger cohort of trauma patients than has previously been reported. Methods Data were obtained from the National Trauma Data Bank from 1994 to 2005. Of the 884,700 patients who met inclusion criteria, 0.11% had a known diagnosis of cirrhosis ( n = 956). Information regarding demographics, injury severity, preexisting comorbidities, and presence or absence of laparotomy was collected. Primary outcome measures were mortality and pulmonary, hematologic, infectious, and cardiac complications. Age, injury severity, comorbidities, and laparotomy status were analyzed as independent variables using logistic regression. Results The overall mortality rate for patients with cirrhosis was more than four times higher than patients without cirrhosis (17.7% versus 4.4%, P P P Discussion Cirrhosis is a strong predictor of poor outcome in trauma patients, regardless of age, injury severity, or number of comorbidities, especially among those requiring trauma-related laparotomies. Furthermore, TRISS fails to accurately predict survival in this group of patients. This study is the largest of its kind and is powered to detect statistically significant differences for a wide variety of outcomes while controlling for potential confounders. We have confirmed many trends previously seen in smaller studies and provided new information regarding the frequency and proportions of complications seen in this unique population.