Long-term outcome of patients with liver cirrhosis admitted to a general intensive care unit
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 mor...
| Main Authors: | , , , , , , , |
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| Format: | Article |
| Language: | English |
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SpringerOpen
2017-04-01
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| Series: | Annals of Intensive Care |
| Subjects: | |
| Online Access: | http://link.springer.com/article/10.1186/s13613-017-0257-6 |
| _version_ | 1828769245643669504 |
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| author | Alex Warren Charlotte R. Soulsby Alex Puxty Joseph Campbell Martin Shaw Tara Quasim John Kinsella Joanne McPeake |
| author_facet | Alex Warren Charlotte R. Soulsby Alex Puxty Joseph Campbell Martin Shaw Tara Quasim John Kinsella Joanne McPeake |
| author_sort | Alex Warren |
| collection | DOAJ |
| description | 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. |
| first_indexed | 2024-12-11T13:44:29Z |
| format | Article |
| id | doaj.art-8410cfbaf30c433f807a304ab875a718 |
| institution | Directory Open Access Journal |
| issn | 2110-5820 |
| language | English |
| last_indexed | 2024-12-11T13:44:29Z |
| publishDate | 2017-04-01 |
| publisher | SpringerOpen |
| record_format | Article |
| series | Annals of Intensive Care |
| spelling | doaj.art-8410cfbaf30c433f807a304ab875a7182022-12-22T01:04:35ZengSpringerOpenAnnals of Intensive Care2110-58202017-04-01711910.1186/s13613-017-0257-6Long-term outcome of patients with liver cirrhosis admitted to a general intensive care unitAlex Warren0Charlotte R. Soulsby1Alex Puxty2Joseph Campbell3Martin Shaw4Tara Quasim5John Kinsella6Joanne McPeake7Academic Unit of Anaesthesia, Pain and Critical Care, University of GlasgowAcademic Unit of Anaesthesia, Pain and Critical Care, University of GlasgowIntensive Care Unit, NHS Greater Glasgow and ClydeAcademic Unit of Anaesthesia, Pain and Critical Care, University of GlasgowMedical Physics, NHS Greater Glasgow and ClydeAcademic Unit of Anaesthesia, Pain and Critical Care, University of GlasgowAcademic Unit of Anaesthesia, Pain and Critical Care, University of GlasgowAcademic Unit of Anaesthesia, Pain and Critical Care, University of GlasgowAbstract 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.http://link.springer.com/article/10.1186/s13613-017-0257-6Critical careCirrhosisScoring toolsChild–PughLactate |
| spellingShingle | Alex Warren Charlotte R. Soulsby Alex Puxty Joseph Campbell Martin Shaw Tara Quasim John Kinsella Joanne McPeake Long-term outcome of patients with liver cirrhosis admitted to a general intensive care unit Annals of Intensive Care Critical care Cirrhosis Scoring tools Child–Pugh Lactate |
| title | Long-term outcome of patients with liver cirrhosis admitted to a general intensive care unit |
| title_full | Long-term outcome of patients with liver cirrhosis admitted to a general intensive care unit |
| title_fullStr | Long-term outcome of patients with liver cirrhosis admitted to a general intensive care unit |
| title_full_unstemmed | Long-term outcome of patients with liver cirrhosis admitted to a general intensive care unit |
| title_short | Long-term outcome of patients with liver cirrhosis admitted to a general intensive care unit |
| title_sort | long term outcome of patients with liver cirrhosis admitted to a general intensive care unit |
| topic | Critical care Cirrhosis Scoring tools Child–Pugh Lactate |
| url | http://link.springer.com/article/10.1186/s13613-017-0257-6 |
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