Impact of cirrhosis on outcomes in trauma.
BACKGROUND
Cirrhosis as an independent predictor of poor outcomes in trauma patients was identified in 1990. We hypothesized that the degree of preinjury hepatic dysfunction is, by itself, an independent predictor of mortality.


METHODS
The trauma registry at our Level I trauma center was queried for all ICD-9 codes for liver disease from 1999 to 2003, and patients were categorized as having Child-Turcotte-Pugh (CTP) class A, B, or C cirrhosis. Data analyzed included age, mechanism of injury, Abbreviated Injury Score (AIS), Injury Severity Score (ISS), Glasgow Coma Score (GCS), hospital length of stay, ventilator days, procedures performed, transfusion of blood products, admission lactate, base deficit, and mortality. Trauma Related Injury Severity Score (TRISS) methodology was used to calculate the probability of survival. Outcomes data were analyzed, and statistical comparison was performed using group t-test.


RESULTS
Of the 50 patients meeting study criteria, 31 had alcohol-related cirrhosis, 18 had a history of hepatitis C, and 1 had cryptogenic cirrhosis. Twenty (40%) met CTP A classification, 16 (32%) met CTP B criteria, and 14 (28%) had CTP class C cirrhosis. One death occurred in the CTP A and B groups. Comparison between the five survivors and nine nonsurvivors from CTP class C showed no statistical significance in terms of age, ISS, TRISS, or GCS.


CONCLUSIONS
The mortality rate for class C cirrhotic patients posttrauma continues to be higher than that predicted by TRISS, although patients with less severe hepatic dysfunction do not appear to have significantly lower than predicted survival. The degree of hepatic dysfunction remains an independent predictor of mortality and CTP C criteria must be considered when determining outcomes for patients posttrauma.
Dangleben
Dale A
DA
Department of Surgery, Lehigh Valley Hospital, Allentown, PA 18105-1556, USA.
Jazaeri
Omid
O
Wasser
Thomas
T
Cipolle
Mark
M
Pasquale
Michael
M
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001803:Blood Transfusion; D006801:Humans; D008103:Liver Cirrhosis / Q000145:classification / Q000150:complications / Q000401:mortality*; D008297:Male; D008875:Middle Aged; D015996:Survival Rate; D015599:Trauma Severity Indices; D014947:Wounds and Injuries / Q000145:classification / Q000150:complications / Q000401:mortality* / Q000601:surgery