Journal Article

Prevalence and outcome of cirrhosis patients admitted to UK intensive care: a comparison against dialysis-dependent chronic renal failure patients

Welch, Cathy A., O’Brien, Alastair J., Singer, Mervyn, Harrison, David A.

2012

Overview

Purpose Patients with decompensated liver cirrhosis who are admitted to intensive care units (ICU) are perceived, within the UK, as having a particularly poor prognosis. Methods We performed a descriptive analysis of cirrhosis patients admitted to general critical care units 1995–2008 compared to patients admitted with pre-existing chronic renal failure. Data were obtained from the Intensive Care National Audit and Research Centre Case Mix Programme Database incorporating 192 adult critical care units in England, Wales and Northern Ireland. Results Cirrhosis accounted for 2.6 % (16,096 patients) of total admissions with mean age 52.5 years and male preponderance (~60 %). Hospital mortality was high (>55 %) although this improved 5 % in recent years, and median length of stay was short (2.5 days). Mortality in cirrhotics with severe sepsis requiring organ support was 65–90 %, compared to 33–39 % in those without. Conversely, patients with chronic renal failure had lower mortality (42 %) despite similar characteristics and higher acute physiology and chronic health evaluation (APACHE) II scores. The APACHE II score under-predicted mortality in cirrhotics. Conclusions Cirrhosis patients exhibit worse outcomes compared to pre-existing renal failure patients, despite similar characteristics. Survival worsens considerably with organ failure, especially with sepsis. They represent a small number of admissions, albeit increasing over recent years, and, in general, have a short ICU stay. Patients with single organ failure have acceptable survival rates and mortality has improved; although we have no data on those refused ICU admission potentially causing survival bias. Given the extremely high mortality in patients with multi-organ failure, support should be limited/withdrawn in such patients.

• Publisher: Springer-Verlag,Springer,Springer Nature B.V
• Subject: Analysis / Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy / Anesthesiology / Audits / Biological and medical sciences / Chronic kidney failure / Clinical death. Palliative care. Organ gift and preservation / Critical care / Critical Care Medicine / Diagnosis-Related Groups / Emergency Medicine / Failure / Female / Fibrosis - epidemiology / Hemodialysis / Hospitals / Humans / Intensive / Intensive care / Intensive care medicine / Intensive Care Units / Kidney Failure, Chronic - therapy / Length of stay / Liver / Liver cirrhosis / Liver diseases / Liver transplants / Male / Medical Audit / Medical prognosis / Medical research / Medical sciences / Medicine / Medicine & Public Health / Medicine, Experimental / Middle Aged / Mortality / Original / Outcome Assessment (Health Care) / Pain Medicine / Patient outcomes / Pediatrics / Physiology / Pneumology/Respiratory System / Prevalence / Renal Dialysis / Renal replacement therapy / Research centers / Sepsis / United Kingdom / United Kingdom - epidemiology