[Mortality and prognostic factors of the cirrhotic patients with hepatic encephalopathy admitted to medical intensive care unit].
OBJECTIVE
To assess mortality and to identify variables that could predict it in cirrhotic patients hospitalized to the medical intensive care unit (MICU) for hepatic encephalopathy (HE).


METHODS
Retrospective cohort study.


METHODS
From January 1995 to December 2004, the cirrhotic patients admitted consecutively in MICU were screened and those with altered level of consciousness were included. The MICU mortality rate was assessed. Nearly 80 variables were analyzed and compared between survivors and non-survivors.


METHODS
t test, chi(2) or Fisher exact tests, Kaplan-Meier and log rank, Cox regression analysis.


RESULTS
A total of 180 patients (42 women-138 men, mean age: 59+/-10 years) were admitted (incidence: 2.6%). The SAPS II was 30.1+/-11, Acute Physiology Age and Chronic Health Evaluation II (APACHE II): 16.5+/-5.3, Child-Pugh score: 9.1+/-1.9 and GCS: 11+/-2.8. The causes of liver cirrhosis was identified in 41.2% of cases (viral: 35.6%, alcohol: 5.6%). Nearly 18% of patients had an antecedent of HE. The causes of HE were: infection (65.6%), upper gastrointestinal bleeding (32.2%), drugs (5%) and metabolic cause (5%). MICU mortality rate was 33.3% and seemed higher in gastrointestinal bleeding. Eighteen variables were significantly associated with poor prognosis in univariate analysis. Only three variables remained significant in multivariate analysis: systolic blood pressure<90 mmHg (RR=4; IC 95%=2-8.1), total WBC>12000 n/mm(3) (RR=3.1; IC 95%=1.8-5.3) and use of mechanical ventilation (RR=3.1; IC 95%=1.7-5.6).


CONCLUSIONS
The MICU mortality of cirrhotic patients with HE was high and significantly associated with haemodynamic instability, hyperleucocytosis and mechanical ventilation.
Benhaddouch
Z
Z
Service des urgences et de réanimation médicale, hôpital Ibn-Sina, CHU Ibn-Sina, BP 1005, 10100 Rabat, Morocco.
Abidi
K
K
Naoufel
M
M
Abouqal
R
R
Zeggwagh
A A
AA
D000368:Aged; D015331:Cohort Studies; D005260:Female; D006501:Hepatic Encephalopathy / Q000209:etiology* / Q000401:mortality*; D006801:Humans; D007362:Intensive Care Units; D008103:Liver Cirrhosis / Q000150:complications*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011379:Prognosis; D012189:Retrospective Studies