title: Incidence and prognosis of early hepatic dysfunction in critically ill patients--a prospective multicenter study.
abstract: OBJECTIVE
  In critically ill patients, hepatic dysfunction is regarded as a late organ failure associated with poor prognosis. We investigated the incidence and prognostic implications of early hepatic dysfunction (serum bilirubin >2 mg/dL within 48 hrs of admission).
  
  
  METHODS
  Prospective, multicenter cohort study.
  
  
  METHODS
  Thirty-two medical, surgical, and mixed intensive care units.
  
  
  METHODS
  A total of 38,036 adult patients admitted consecutively over a period of 4 yrs.
  
  
  METHODS
  None.
  
  
  RESULTS
  Excluding patients with preexisting cirrhosis (n = 691; 1.8%) and acute or acute-on-chronic hepatic failure (n = 108, 0.3%), we identified 4,146 patients (10.9%) with early hepatic dysfunction. These patients had different baseline characteristics, longer median intensive care unit stays (5 vs. 3 days; p < .001) and increased hospital mortality (30.4% vs. 16.4%; p < .001). Hepatic dysfunction was also associated with higher observed-to-expected mortality ratios (1.02 vs. 0.91; p < .001). Multiple logistic regression analysis showed an independent mortality risk of hepatic dysfunction (odds ratio, 1.86; 95% confidence interval, 1.71-2.03; p < .001), which exceeded the impact of all other organ dysfunctions. A case-control study further confirmed these results: Patients with early hepatic dysfunction exhibited significantly increased raw and risk-adjusted mortality compared with control subjects.
  
  
  CONCLUSIONS
  Our results provide strong evidence that early hepatic dysfunction, occurring in 11% of critically ill patients, presents a specific and independent risk factor for poor prognosis.
authors.affiliation: Department of Medicine IV, Core Unit for Medical Statistics and Informatics, Medical University of Vienna, Vienna General Hospital, A-1090 Vienna, Austria.
authors.forename: Ludwig
authors.initials: L
authors.lastname: Kramer
authors.forename: Barbara
authors.initials: B
authors.lastname: Jordan
authors.forename: Wilfred
authors.initials: W
authors.lastname: Druml
authors.forename: Peter
authors.initials: P
authors.lastname: Bauer
authors.forename: Philipp G H
authors.initials: PG
authors.lastname: Metnitz
mesh_terms: D016022:Case-Control Studies; D016638:Critical Illness / Q000453:epidemiology* / Q000401:mortality; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D015994:Incidence; D007902:Length of Stay / Q000706:statistics & numerical data; D008107:Liver Diseases / Q000175:diagnosis* / Q000453:epidemiology*; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care / Q000706:statistics & numerical data; D011379:Prognosis; D011446:Prospective Studies; D018570:Risk Assessment