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. 2023 Jan;43(1):49-59.
doi: 10.1111/liv.15285. Epub 2022 May 15.

Improved survival of cirrhotic patients with infections in Australian and New Zealand ICUs between 2005 and 2017

Ammar Majeed  1   2 , Michael Bailey  3   4 , William Kemp  1   2 , Avik Majumdar  5   6 , Rinaldo Bellomo  3 , David Pilcher  3   4   7 , Stuart K Roberts  1   2
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Improved survival of cirrhotic patients with infections in Australian and New Zealand ICUs between 2005 and 2017

Ammar Majeed et al. Liver Int. 2023 Jan.

Abstract

Background & aims: Changes in outcomes of cirrhotic patients admitted to intensive care units (ICUs) with infections are poorly understood. We aimed to describe changes over time in outcomes for such patients and to compare them to other ICU admissions.

Methods: Analysis of consecutive admissions to 188 ICUs between 2005 and 2017 as recorded in the Australian and New Zealand Intensive Care Society Centre for Outcome and Research Evaluation Adult Patient Database.

Results: Admissions for cirrhotic patients with infections accounted for 4645 (0.6%) of 813 189 non-elective ICU admissions. Hospital mortality rate (35.5%) was significantly higher compared with other cirrhotic patients' admissions (28.5%), and other ICU admissions for infection (17.1%, p < .0001), and increased to 52.2% in the presence of acute-on-chronic liver failure (ACLF). Hospital mortality in cirrhotic patients' ICU admissions for infection decreased significantly over time (annual decline odds ratio, 0.97; 95% CI, 0.95-0.99, p = .002). There was a comparable reduction in-hospital mortality rates over time in other ICU admissions for infections and other cirrhotic patients' ICU admissions. However, mortality rates did not change over time in the ACLF subgroup. Median hospital and ICU length of stays for cirrhotic patients' ICU admissions for infections were 12.1 and 3.5 days, respectively, and decreased significantly by 1 day every 4 years in-hospital survivors(p < .0001).

Conclusion: Hospital mortality in ICU admissions for cirrhotic patients with infection is double that of non-cirrhotic patients with infection but has declined significantly over time. Outcomes in the subgroup with ACLF remained poor without significant improvement over the study period.

Keywords: ICU; cirrhosis; hospital mortality; incidence; infection; length of stay.

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