Research Article
Declining mortality in critically ill patients with cirrhosis in Australia and New Zealand between 2000 and 2015Author links open overlay panelAvikMajumdar12MichaelBailey34William M.Kemp1RinaldoBellomo3Stuart K.Roberts1DavidPilcher3451Department of Gastroenterology, The Alfred Hospital, Melbourne, Australia2AW Morrow Gastroenterology and Liver Centre, Royal Prince Alfred Hospital, Sydney, Australia3Australian and New Zealand Intensive Care Research Centre (ANZIC RC), Department of Epidemiology and Preventive Medicine, Monash University, Australia4ANZICS Centre for Outcome and Resource Evaluation (CORE), Melbourne, Australia5Department of Intensive Care, The Alfred Hospital, Melbourne, Australia
Received 2 March 2017, Revised 7 July 2017, Accepted 24 July 2017, Available online 9 August 2017.
https://doi.org/10.1016/j.jhep.2017.07.024Get rights and content
Highlights•The mortality of patients with cirrhosis admitted to ICU on a non-elective basis has declined significantly over time. •The presence of cirrhosis independently increased the risk of death in-hospital by 10%. •Outcomes are similar between non-liver transplant ICUs and liver transplant centres. •Better access to intensive care for patients with cirrhosis is recommended.
Background & AimsFew studies have described the outcomes of patients with cirrhosis receiving intensive care unit (ICU) admission at a population level. We aimed to describe trends in the mortality of such patients in Australia and New Zealand (ANZ), and to investigate the relationship with associated organ failures.
MethodsWe studied patients admitted to 172 ICUs on a non-elective basis, with and without cirrhosis between January 1st 2000 and December 31st 2015, as recorded by the ANZ Intensive Care Society Centre for Outcome and Resource Evaluation Adult Patient Database. We assessed severity of illness on admission using organ failure models and acute physiology scores. The primary outcome was hospital mortality.
ResultsPatients with cirrhosis accounted for 17,044 of 776,873 non-elective ICU admissions (2.2%). Cirrhosis hospital mortality was 32.4% compared to 16.9% in the non-cirrhotic group (p <0.0001). After adjustment for key confounders, cirrhosis had an independent effect on mortality with an odds ratio (OR) of 1.10 (1.06–1.15). There was no difference in the adjusted annual decline in mortality between patients with or without cirrhosis (OR 0.96 [0.95–0.97] vs. 0.96 [0.96–0.96], p = 0.67). No difference was seen in the adjusted decline in mortality of patients with cirrhosis when stratified by mechanical ventilation (p = 0.92), liver transplant centre status (p = 0.27) or presence of sepsis (p = 0.09). Mortality increased with number of organ failures, however, the presence of cirrhosis was not found to affect this relationship (p = 0.33).
ConclusionsThe mortality of patients with cirrhosis admitted to ICU on a non-elective basis has declined significantly over time, comparable to patients without cirrhosis, and is predominantly governed by the number of organ failures. Outcomes are similar between non-liver transplant ICUs and liver transplant centres.
Lay summaryThe outcomes of patients with liver cirrhosis admitted to intensive care units (ICUs) have been previously regarded as poor. We have demonstrated that in Australia and New Zealand, annual in-hospital death rates following ICU admission in this patient group are lower than previously reported, have improved over 16 years to 29% and are at a rate similar to patients without cirrhosis. Our data justify recommendations that advocate better access to intensive care for patients with cirrhosis.
Graphical abstract
KeywordsIntensive care unit
Critical care
Cirrhosis
Portal hypertension
Organ failure
Sepsis
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发表于 2017-11-18 11:20