One year outcome of intensive care patients with decompensated alcoholic liver disease.
BACKGROUND
We aimed to examine the outcome of patients with decompensated alcoholic liver disease (ALD) admitted to a general intensive care unit (ICU).


METHODS
Retrospective observational cohort study of intensive care admissions over a 3 yr period was conducted. The study was set in an ICU in a UK university hospital with a tertiary liver referral unit. One hundred and ten admissions, involving 107 patients, with decompensated ALD were included. Intensive care, hospital, and 6 and 12 months mortality were recorded along with the outcome in diagnostic and organ system support subgroups. Intensive care, hospital, 6 month and 12 month mortality rates were 58, 71, 78 and 81%.


RESULTS
Hospital mortality in the sepsis/multiorgan failure group was 88%. Sixty-nine per cent of patients who were ventilated but required no other organ support survived to hospital discharge. However, the requirement for any other organ support, or a raised creatinine (>120 micromol litre(-1)) in the first 24 h, reduced the hospital survival to <15%. In those patients requiring acute renal replacement therapy, the hospital mortality was 94%.


CONCLUSIONS
Decompensated ALD requiring intensive care admission is associated with a high hospital mortality and consideration should be given to the futility of escalating organ support measures, particularly when renal replacement therapy is required.
Mackle
I J
IJ
Department of Anaesthesia, Critical Care and Pain Management, The Royal Infirmary of Edinburgh at Little France, 51 Little France Crescent, Edinburgh EH16 4SA, UK.
Swann
D G
DG
Cook
B
B
D018806:APACHE; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003422:Critical Care / Q000379:methods; D004812:Epidemiologic Methods; D005260:Female; D006801:Humans; D008108:Liver Diseases, Alcoholic / Q000150:complications / Q000175:diagnosis* / Q000628:therapy; D008297:Male; D008875:Middle Aged; D009102:Multiple Organ Failure / Q000209:etiology; D011379:Prognosis; D017582:Renal Replacement Therapy; D012606:Scotland; D016896:Treatment Outcome