Outcome prediction for patients with chronic liver disease requiring medical intensive care

Introduction

To determine the outcome and prognostic factors of patients with cirrhosis of the liver requiring medical intensive care

Patients and methods

All patients with chronic liver disease and cirrhosis admitted to the medical ICU between 7/95 and 6/97 were enrolled in the study. Prospectively the reason for ICU admission, acute diagnoses, presence of co-morbid illness, stage of liver disease, number and length of organ failures, daily APACHE II and TISS classification and outcome were documented. Laboratory values were drawn retrospectively from the charts. Patients with multiple ICU treatments were reviewed only for the initial admission. Contingency tables were analysed using Χ² test, continuous variables were compared using Mann–Whitney U test.

Results

One hundred and two patients met the study criteria; mean age was 51 ± 12 (± SD) years, median 50, range 28–78 years, 67% were male. Mean ICU length of stay was 8.6 ± 14.7 days. Mean APACHE II score (first 24 h) was 20 ± 11, range 5–48. Mean TISS score (first 24 h) was 30 ± 14, range 0–69. ICU mortality was 38%, a significant association was seen between ICU mortality and the following variables: sepsis (P = 0.000001), pneumonia (P = 0.0027), elevated serum lactate (P = 0.00003) and CRP (P = 0.00001) on admission, respirator, renal replacement or catecholamine therapy (all P = 0.00001), Child–Pugh (P = 0.19) and APACHE II score (P = 0.00001) within the first 24 h. No significant association was noted between ICU mortality and age (P = 0.89), length of stay (P = 0.12), gastrointestinal bleeding (P = 0.15), spontaneous bacterial peritonitis (P = 0.31), and the etiology of liver disease (alcohol, viral, both combined, others P = 0.68).

Conclusion

Among critically ill patients with cirrhosis of the liver ICU mortality was 38%, in comparison, the mortality for all ICU admissions in this period of time was 23%. APACHE II score and variables describing single or multiple organ dysfunction and pulmonary infection are excellent predictors of mortality.