Does intubation really equal death in cirrhotic patients? Factors influencing outcome in patients with liver cirrhosis requiring mechanical ventilation.
OBJECTIVE
It is not known whether the poor outcome of ventilated cirrhotic patients is related to the severity of the underlying liver disease or to the severity of the acute illness for which ICU care is required. This study examines parameters both of chronic liver disease and of acute illness with regard to their influence on outcome in mechanically ventilated cirrhotic patients.


METHODS
Retrospective observational case series in a 9-bed medical ICU in an academic tertiary care center.


METHODS
Seventy-six consecutive cirrhotic patients who received mechanical ventilation were identified. Clinical and laboratory parameters were compared between ICU survivors and ICU deaths.


RESULTS
There were 45/76 (59%) patients who died during their ICU stay. By univariate analysis, the Child-Pugh score, its components (serum bilirubin, prothrombin time), ALT, creatinine concentration, a clinical suspicion of infection, and the APACHE II score, but not the acute physiology score (APS), differed significantly between ICU survivors and ICU non-survivors. The Child-Pugh score was highly correlated to ICU mortality both in logistic regression analysis and receiver-operating characteristics analysis. Conversely, markers of acute illness, in particular the APS component of the APACHE II score, did not predict ICU survival.


CONCLUSIONS
Markers of advanced chronic liver disease but not of the severity of acute illness are correlated to ICU outcome in ventilated cirrhotic patients. The outcome of advanced cases (Child-Pugh score of 12 and above) is poor.
Department of Medicine I, University of Bonn, Sigmund-Freud-Strasse 25, 53105 Bonn, Germany. Rabe@uni-bonn.de
Christian
C
Rabe
Volker
V
Schmitz
Michael
M
Paashaus
Annemarie
A
Musch
Helga
H
Zickermann
Franz-Ludwig
FL
Dumoulin
Tilman
T
Sauerbruch
Wolfgang H
WH
Caselmann
D000293:Adolescent; D000328:Adult; D000368:Aged; D002423:Cause of Death; D003627:Data Interpretation, Statistical; D005260:Female; D006801:Humans; D008103:Liver Cirrhosis / Q000401:mortality*; D008111:Liver Function Tests; D008297:Male; D008875:Middle Aged; D012121:Respiration, Artificial / Q000009:adverse effects*; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index