title: Improvement in the prognosis of cirrhotic patients admitted to an intensive care unit, a retrospective study.
abstract: OBJECTIVE
  To examine how the outcomes of cirrhotic patients admitted to an ICU have changed over time.
  
  
  METHODS
  A retrospective study in a medical ICU during two separate 3-year periods [period 1 (P1): 1995-1998 and period 2 (P2): 2005-2008].
  
  
  RESULTS
  A total of 56 cirrhotic patients were admitted during P1 and 138 during P2, accounting for 2.3 and 4.5% of the total ICU admissions (P<0.01). Patients' characteristics were markedly different between the two periods: previous functional status improved (Knaus scale, A/B/C/D: P1 - 7.1%/53.6%/35.7%/3.6% vs. P2 - 28.2%/47.8%/22.5%/1.5%, P<0.01), the number of comorbidities decreased (Charlson: 1.79±2.22 vs. 1.02±1.40, P=0.02), the severity of cirrhosis increased [Child-Pugh: 8 (7-13) vs. 11 (8-13), P=0.04; Model for End-Stage Liver Disease: 16 (12-28) vs. 22 (15-31), P=0.02], and acute organ dysfunctions increased (Sequential Organ Failure Assessment: 7.3±5.6 vs. 11.3±5.5, P<0.01). The crude in-ICU mortality was similar during the two periods (39.3 vs. 41.3%, P=0.92). However, after adjustment for severity, in-ICU mortality was markedly decreased during P2 (odds ratio: 0.36 [0.15; 0.88], P=0.02).
  
  
  CONCLUSIONS
  Cirrhotic patients admitted to the ICU have an improved outcome despite increased severity of liver disease. This improvement is associated with a higher selection according to their previous functional status and comorbidities.
authors.affiliation: AP-HP, Saint-Antoine Hospital, Medical Intensive Care Unit, 184 rue du faubourg, Saint-Antoine, Paris Cedex 12, France. galbois@gmail.com
authors.forename: Arnaud
authors.initials: A
authors.lastname: Galbois
authors.forename: Marie-Laëtitia
authors.initials: ML
authors.lastname: Trompette
authors.forename: Vincent
authors.initials: V
authors.lastname: Das
authors.forename: Pierre-Yves
authors.initials: PY
authors.lastname: Boëlle
authors.forename: Nicolas
authors.initials: N
authors.lastname: Carbonell
authors.forename: Dominique
authors.initials: D
authors.lastname: Thabut
authors.forename: Chantal
authors.initials: C
authors.lastname: Housset
authors.forename: Hafid
authors.initials: H
authors.lastname: Ait-Oufella
authors.forename: Georges
authors.initials: G
authors.lastname: Offenstadt
authors.forename: Eric
authors.initials: E
authors.lastname: Maury
authors.forename: Bertrand
authors.initials: B
authors.lastname: Guidet
mesh_terms: D000328:Adult; D000368:Aged; D058625:End Stage Liver Disease / Q000401:mortality; D005260:Female; D006801:Humans; D007362:Intensive Care Units / Q000706:statistics & numerical data* / Q000639:trends; D007902:Length of Stay; D008103:Liver Cirrhosis / Q000150:complications / Q000401:mortality* / Q000503:physiopathology / Q000628:therapy; D008297:Male; D008875:Middle Aged; D009102:Multiple Organ Failure / Q000628:therapy; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index