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. 2017 Dec;7(1):37.
doi: 10.1186/s13613-017-0257-6. Epub 2017 Apr 4.

Long-term outcome of patients with liver cirrhosis admitted to a general intensive care unit

Alex Warren  1 , Charlotte R Soulsby  1 , Alex Puxty  2 , Joseph Campbell  1 , Martin Shaw  3 , Tara Quasim  1   2 , John Kinsella  1 , Joanne McPeake  4   5
Affiliations

Long-term outcome of patients with liver cirrhosis admitted to a general intensive care unit

Alex Warren et al. Ann Intensive Care. 2017 Dec.

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.

Keywords: Child–Pugh; Cirrhosis; Critical care; Lactate; Scoring tools.

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Figures

Fig. 1
Fig. 1
Summary of 18-month observational cohort study of patients with cirrhosis admitted to a general ICU
Fig. 2
Fig. 2
Kaplan–Meier survival curve of 68 patients with cirrhosis admitted to a general ICU
Fig. 3
Fig. 3
Kaplan–Meier survival curve stratified by Child–Pugh class at ICU admission. Black lines Child–Pugh class A (n = 6). Green lines Child–Pugh class B (n = 34). Red lines Child–Pugh class C (n = 28). Log-rank p value = 0.002
Fig. 4
Fig. 4
Kaplan–Meier survival curve stratified by ABC + Lactate class at ICU admission. Black lines ABC + Lactate class 1 (n = 27). Green lines ABC + Lactate class 2 (n = 24). Red lines ABC + Lactate class 3 (n = 15). Log-rank p value = 0.001
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