Long-term outcome of patients with liver cirrhosis admitted to a general intensive care unit

Warren, A., Soulsby, C. R., Puxty, A., Campbell, J., Shaw, M., Quasim, T. , Kinsella, J. and McPeake, J. (2017) Long-term outcome of patients with liver cirrhosis admitted to a general intensive care unit. Annals of Intensive Care, 7, 37. (doi:10.1186/s13613-017-0257-6) (PMID:28374334)

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Abstract

Objectives: The 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. Design: Observational cohort study. Setting: General adult critical care unit in a UK teaching hospital. Patients: Eighty-four patients admitted to critical care between June 2012 and December 2013. Primary outcome measures: Cumulative survival at ICU discharge, hospital discharge and 12 months. Results: Eighty-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%. Conclusions: 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. The ABC + Lactate classification system may be useful in identifying critically ill cirrhotic patients with very high long-term mortality.

Item Type:Articles
Keywords:Child–Pugh, cirrhosis, critical care, lactate, scoring tools.
Status:Published
Refereed:Yes
Glasgow Author(s) Enlighten ID:Quasim, Dr Tara and Kinsella, Professor John and Soulsby, Dr Charlotte and McPeake, Dr Joanne and Shaw, Mr Martin
Authors: Warren, A., Soulsby, C. R., Puxty, A., Campbell, J., Shaw, M., Quasim, T., Kinsella, J., and McPeake, J.
College/School:College of Medical Veterinary and Life Sciences > School of Medicine, Dentistry & Nursing
Journal Name:Annals of Intensive Care
Publisher:SpringerOpen
ISSN:2110-5820
ISSN (Online):2110-5820
Copyright Holders:Copyright © 2017 The Authors
First Published:First published in Annals of Intensive Care 7:37
Publisher Policy:Reproduced under a Creative Commons License

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