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. 2023 Jun;68(6):2344-2359.
doi: 10.1007/s10620-023-07856-x. Epub 2023 Feb 12.

Clinical Predictors of Intensive Care Unit Transfer in Admitted Patients with Cirrhosis

Matthew Dukewich  1 , Chung-Heng Liu  2 , Ethan M Weinberg  3   4 , Nadim Mahmud  5 , K Rajender Reddy  5
Affiliations

Clinical Predictors of Intensive Care Unit Transfer in Admitted Patients with Cirrhosis

Matthew Dukewich et al. Dig Dis Sci. 2023 Jun.

Abstract

Background: Patients with cirrhosis are at high risk of mortality after organ failure that requires ICU care. There have been attempts to predict which patients are at highest risk, with some success found in adapting liver disease-specific scoring systems with clinical variables commonly associated with critical illness. However, the clinical factors predictive of which patients with cirrhosis are most at-risk of needing ICU level care are unknown.

Aims: Our study set out to better understand which clinical variables were associated with need for ICU care in patients with cirrhosis.

Methods: Retrospective analysis of admitted patients with cirrhosis at single tertiary care center.

Results: Patients with cirrhosis admitted to our center were categorized into three groups: those without ICU transfer, those admitted to the ICU directly from the emergency department (ED), and those admitted to the ICU from the medicine floor. These groups differed in mortality at 30 days (3.5% vs. 15% vs. 25%, P < 0.001) and at subsequent intervals up to 1 year. These groups differed in indication for ICU transfer, with GI bleed, hemorrhagic shock, hepatic encephalopathy, and hyponatremia occurring more in the ED-to-ICU group, while respiratory failure was more common in the floor-to-ICU group. In multivariable analysis, factors associated with ICU transfer included worsened kidney function, anemia, hyponatremia, leukocytosis, and the decision to obtain a lactate level. Similar analysis with only floor-to-ICU patients found that ICU transfer was associated with hypoalbuminemia, hyponatremia, hypotension, and SIRS score.

Conclusion: Our study found significant differences in mortality among three distinct groups of patients with cirrhosis. A risk factor model for ICU transfer found that variables both specific and nonspecific to liver disease were associated with ICU transfer, with between-group differences supporting the idea of different clinical phenotypes and suggesting factors that should be considered in early triage and assessment of hospitalized patients with cirrhosis.

Keywords: Critical illness; Decompensated liver disease; End-stage liver disease; Intensive care unit care.

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Conflict of interest statement

Conflict of interest No authors have conflicts of interest or financial disclosures to disclose related to the material presented in this manuscript.

Figures

Fig. 1
Fig. 1
Significant variables on admission stratified by group
Fig. 2
Fig. 2
Kaplan–Meier curve of survival after admission stratified by group
See this image and copyright information in PMC

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