90-day Case-Fatality in Critically ill Patients with Chronic Liver Disease Influenced by Presence of Portal Hypertension,Results from a Multicentre Retrospective Cohort Study

Abstract

Background

Critical illness in patients with chronic liver disease (CLD) is increasing in occurrence, and by virtue of its adverse effect on prognosis, its presence may influence the decision to offer admission to intensive care units (ICU). Our objective was to examine the determinants and outcome of patients with CLD admitted to ICU.

Methods

A retrospective cohort of patients admitted to four adult ICUs in Queensland, Australia from 2017 to 2019. Patients with mild or moderate-severe CLD were defined by the absence and presence of portal hypertension, respectively, and were was determined using granular ICU and state-wide administrative databases. The primary outcome was 90-day all cause case-fatality.

Results

We included 3836 patients in the analysis, of which, 60 (2%) had mild liver disease and 132 (3%) had moderate-severe liver disease . Patients with CLD had higher incidence of other co-morbidities with the median adjusted-Charlson co-morbidity index (CCI) was 1 (interquartile range; IQR 0-3) for no CLD, 2 (IQR 1.5-4) for mild CLD, and 3 (IQR 2-5) for moderate-severe CLD. Case-fatality rates at 90 days was 17% for no CLD, 25% for mild CLD, and 41% for moderate-severe CLD. Among those with mild and moderate-severe CLD, an increased co-morbidity burden as measured by an adjusted CCI score of low (0-3), medium (4-5), high (6-7) and very high (>7) resulted in increasing case-fatality rates of 24–40%, 11–28.5%, 33–62%, and 50% respectively. Moderate-severe CLD, but not mild CLD, was independently associated with increased case-fatality at 90 days (Odds Ratio 1.58; 95% confidence interval 1.01-2.48; p = 0.004) after adjusting for medical co-morbidities and severity of illness using logistic regression analysis.

Conclusions

Although patients with moderate-severe CLD have an increased risk for 90-day case-fatality, patients with mild CLD are not at higher risk for death following ICU admission.

Keywords

chronic liver disease critical illness mortality

Get full access to this article

View all access options for this article.

References

Moon

Singal

Tapper

. Contemporary epidemiology of chronic liver disease and cirrhosis. Clin Gastroenterol Hepatol. 2020;18(12):2650‐2666. doi:10.1016/j.cgh.2019.07.060

O'Brien

Welch

Singer

Harrison

. Prevalence and outcome of cirrhosis patients admitted to UK intensive care: a comparison against dialysis-dependent chronic renal failure patients. Intensive Care Med. 2012;38(6):991‐1000. doi:10.1007/s00134-012-2523-2

Olson

Karvellas

. Critical care management of the patient with cirrhosis awaiting liver transplant in the intensive care unit. Liver Transpl. 2017;23(11):1465‐1476. doi:10.1002/lt.24815

Adams

Franklin

. Prognosis of patients with cirrhosis and chronic liver disease admitted to the medical intensive care unit. Crit Care Med. 1989;17(8):843‐844. doi:10.1097/00003246-198908000-00030

Weil

Levesque

McPhail

, et al. Prognosis of cirrhotic patients admitted to intensive care unit: a meta-analysis. Ann Intensive Care. 2017;7(1):33. doi:10.1186/s13613-017-0249-6

Bahirwani

Ghabril

Forde

, et al. Factors that predict short-term intensive care unit mortality in patients with cirrhosis. Clinical Gastroenterology and Hepatology: the Official Clinical Practice Journal of the American Gastroenterological Association. 2013;11(9):1194‐200.e2. doi:10.1016/j.cgh.2013.03.035

McPhail

Shawcross

Abeles

, et al. Increased survival for patients with cirrhosis and organ failure in liver intensive care and validation of the chronic liver failure-sequential organ failure scoring system. Clinical Gastroenterology and Hepatology : the Official Clinical Practice Journal of the American Gastroenterological Association. 2015;13(7):1353–60.e8. doi:10.1016/j.cgh.2014.08.041

Bhakta

Patel

Boutté

Sarmast

Asrani

. Model for end stage liver disease-lactate score and prediction of inpatient mortality in critically ill patients with cirrhosis. Liver Transpl. 2021;12(27):1861-1864.

Levesque

Hoti

Azoulay

, et al. Prospective evaluation of the prognostic scores for cirrhotic patients admitted to an intensive care unit. J Hepatol. 2012;56(1):95‐102. doi:10.1016/j.jhep.2011.06.024

10.

ANZCICS. COMET (Core Outcome Measurement and Evaluation Tool).

11.

ANZICS. ANZICS Centre for Outcome and Resource Evaluation Adult Patient Database.

12.

Wei

Bergquist

Broome

, et al. Acute liver failure in Sweden: etiology and outcome. J Intern Med. 2007;262(3):393‐401. doi:10.1111/j.1365-2796.2007.01818.x

13.

Thygesen

Christiansen

Christensen

Lash

Sørensen

. The predictive value of ICD-10 diagnostic coding used to assess Charlson comorbidity index conditions in the population-based Danish National Registry of Patients. BMC Med Res Methodol. 2011;11(1):83. doi:10.1186/1471-2288-11-83

14.

Quan

Sundararajan

Halfon

, et al. Coding algorithms for defining comorbidities in ICD-9-CM and ICD-10 administrative data. Med Care. 2005;43(11):1130‐1139. doi:10.1097/01.mlr.0000182534.19832.83

15.

Huang

Lin

Cherng

, et al. A population-based cohort study of mortality of intensive care unit patients with liver cirrhosis. BMC Gastroenterol. 2020;20(1):15. doi:10.1186/s12876-020-1163-1

16.

Bhakta

Patel

Boutté

Sarmast

Asrani

. Model for end-stage liver disease lactate score and prediction of inpatient mortality in critically ill patients with cirrhosis. Liver Transpl. 2021;27(12):1861‐1864. doi:10.1002/lt.26076

17.

Drolz

Horvatits

Rutter

, et al. Lactate improves prediction of short-term mortality in critically ill patients with cirrhosis: a multinational study. Hepatology (Baltimore, Md). 2019;69(1):258‐269. doi:10.1002/hep.30151

18.

Jalan

Saliba

Pavesi

, et al. Development and validation of a prognostic score to predict mortality in patients with acute-on-chronic liver failure. J Hepatol. 2014;61(5):1038‐1047. doi:10.1016/j.jhep.2014.06.012

19.

Saliba

Ichai

Levesque

Samuel

. Cirrhotic patients in the ICU: prognostic markers and outcome. Curr Opin Crit Care. 2013;19(2):154‐160. doi:10.1097/MCC.0b013e32835f0c17

20.

Levesque

Saliba

Ichaï

Samuel

. Outcome of patients with cirrhosis requiring mechanical ventilation in ICU. J Hepatol. 2014;60(3):570‐578. doi:10.1016/j.jhep.2013.11.012

21.

Warren

Soulsby

Puxty

, et al. Long-term outcome of patients with liver cirrhosis admitted to a general intensive care unit. Ann Intensive Care. 2017;7(1):37. doi:10.1186/s13613-017-0257-6

Supplementary Material

Please find the following supplemental material available below.

For Open Access articles published under a Creative Commons License, all supplemental material carries the same license as the article it is associated with.

For non-Open Access articles published, all supplemental material carries a non-exclusive license, and permission requests for re-use of supplemental material or any part of supplemental material shall be sent directly to the copyright owner as specified in the copyright notice associated with the article.

0.00 MB

0.01 MB