Outcome of chronic liver disease in a specialist liver intensive therapy unit

Background

Decompensated chronic liver disease (CLD) is associated with high morbidity and mortality. Intensive therapy unit (ITU) admission in this clinical setting consumes significant resources and remains of unproven benefit.

Methods

We examined the records of all patients with chronic liver disease who were admitted to the Liver ITU at King's College Hospital between 1/9/97 and 30/9/98.

Results

One hundred and nine patients were admitted with CLD (M:F 70:39, median age 47 years, range 18–72, aetiology: alcoholic liver disease (ALD) 67%, viral hepatitis 12%, ALD+viral hepatitis 9%, other CLD 12%). Fifty-four (50%) patients survived (including two who underwent liver transplantation) and 55 died. There was no difference in age between survivors and non-survivors (P = 0.5208, unpaired t-test). Seventy-eight patients (72%) were ventilated, of Whom 51 (65%) died. Forty-six patients (42%) were treated with renal support, of whom 42 (91%) died. Of the 4 survivors from the renal supported group 2 underwent liver transplantation. 44 patients (40%) needed both ventilation and renal support, of whom 40 (91%) died.

Conclusion

Patients with decompensated CLD needing ITU care have a high mortality. Single organ support in the form of mechanical ventilation is a reasonable use of resources as there is a good chance of recovery. The need for renal support is a bad prognostic indicator. Unless there is an acute reversible component to renal failure or liver transplantation is contemplated, the use of renal support in this patient group may not be a good use of resources.