Outcome of patients with cirrhosis requiring mechanical ventilation in ICU

Abstract

Introduction: Mortality rate of patients with cirrhosis admitted to the intensive care unit (ICU) and requiring mechanical ventilation varies between 60 and 91%. The aim of our study is to assess the prognosis of these patients, their 1-year outcome and to analyze predictive factors of long-term mortality.

Methods: From May 2005 to May 2011, we studied 246 consecutive patients with cirrhosis requiring mechanical ventilation either at admission or during their ICU stay.

Results: Alcohol was the most common etiology of the cirrhosis (69%). Bleeding related to portal hypertension (30%) and severe sepsis (33%) were the most common reasons for admission. ICU and hospital mortality were respectively 65.9% and 70.3%. Prognostic severity scores, the need for other organ support therapy, infection, and total bilirubin value at ICU admission were significantly associated with ICU mortality. Eighty-four patients (34.1%) were discharged from the ICU. Among these patients, the one-year survival was only of 32%. Logistic regression analysis, using survival at one year as the endpoint, identified two independent risk factors: the length of ventilation (odds ratio [OR] = 1.1; 95% CI, 1.0-1.2; p = 0.02) and total bilirubin at ICU discharge (OR = 1.3; 95% CI, 1.1-1.5; p = 0.006).

Conclusion: Patients with cirrhosis admitted to the liver ICU and who required mechanical ventilation have a poor prognosis with a 1-year mortality of 89%. At ICU discharge, a total bilirubin level higher than 64.5 μmol/L and length of ventilation higher than 9 days could help the hepatologists to identify patients at risk of death in the year following the ICU discharge.

Keywords: ACLF; AUROC; CFU; CLIF-SOFA; CRRT; Cirrhosis; ECMO; HIV; ICU; Intensive care unit; MARS; MCPIS; MELD; MELD-Na; Mechanical ventilation; Mortality; OR; Outcome; ROC; SAPS II; SIRS; SOFA; acute-on-chronic liver failure; areas under receiver operating characteristic; chronic liver failure – sequential organ failure assessment; colony forming units; continuous renal replacement therapy; extracorporeal membrane oxygenation; human immunodeficiency virus; intensive care unit; model for end-stage liver disease; model for end-stage liver disease with incorporation of serum sodium; modified clinical pulmonary infection score; molecular adsorbent recirculating system; odds ratio; receiver operating characteristic; sequential organ failure assessment; simplified acute physiology score; systemic inflammatory response syndrome.