Cirrhosis and trauma are a lethal combination.
BACKGROUND
The objective of this study was to evaluate the risk of mortality and complications associated with cirrhosis in trauma patients.


METHODS
This is an IRB-approved retrospective trauma registry study of patients admitted to an academic level 1 trauma center from 1997 to 2006. The following parameters were abstracted for analysis: age, gender, mechanism of injury, Abbreviated Injury Score, Injury Severity Score, Glasgow Coma Scale, mortality, and complications (ARDS, acute renal failure, pneumonia, intra-abdominal abscess, trauma-associated coagulopathy). Multivariable analysis was utilized to compare the mortality and complication rates between cirrhotic and noncirrhotic trauma patients. The subgroup of patients who underwent laparotomy was also analyzed.


RESULTS
During the 10-year study period there were 36,038 trauma registry patients, of which 468 (1.3%) had a diagnosis of cirrhosis. The mortality in the cirrhotic group was 12% vs. 6% in the noncirrhotic group [adjusted odds ratio = 5.65 (95% CI = 3.72 - 8.41, p < 0.0001)]. ARDS, trauma-associated coagulopathy, and septic complications were significantly more common in the cirrhotic group. The overall severe complication rate in the two groups was 10 and 4%, respectively [adjusted odds ratio = 2.05 (95% CI = 1.45 - 2.84, p < 0.0001)]. For the subgroup of patients who underwent emergent abdominal exploration, the mortality rate increased to 40% compared with that of noncirrhotics at 15% [adjusted odds ratio = 4.35 (95% CI = 2.00 - 9.18, p = 0.0002)].


CONCLUSIONS
Cirrhosis is an independent risk factor for increased mortality and higher complication rate following trauma. Injured patients who undergo laparotomy are significantly more likely to die than noncirrhotic patients. Injured patients with cirrhosis warrant aggressive monitoring and treatment.
Georgiou
Chrysanthos
C
Division of Trauma Surgery and Surgical Critical Care, Department of Surgery, University of Southern California, USC + LAC Medical Center, 1200 North State Street, IPT, C5L100, Los Angeles, CA 90033, USA.
Inaba
Kenji
K
Teixeira
Pedro G R
PG
Hadjizacharia
Pantelis
P
Chan
Linda S
LS
Brown
Carlos
C
Salim
Ali
A
Rhee
Peter
P
Demetriades
Demetrios
D
D015984:Causality; D015897:Comorbidity; D005260:Female; D006801:Humans; D007813:Laparotomy / Q000009:adverse effects / Q000706:statistics & numerical data; D008103:Liver Cirrhosis / Q000401:mortality* / Q000601:surgery; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D012189:Retrospective Studies; D018570:Risk Assessment; D016896:Treatment Outcome; D014947:Wounds and Injuries / Q000401:mortality* / Q000601:surgery