title: Outcome of patients with cirrhosis requiring mechanical ventilation in ICU.
abstract: BACKGROUND
  Mortality rate of patients with cirrhosis admitted to the intensive care unit (ICU) and requiring mechanical ventilation varies between 60 and 91%. The aim of our study is to assess the prognosis of these patients, their 1-year outcome and to analyze predictive factors of long-term mortality.
  
  
  METHODS
  From May 2005 to May 2011, we studied 246 consecutive patients with cirrhosis requiring mechanical ventilation either at admission or during their ICU stay.
  
  
  RESULTS
  Alcohol was the most common etiology of the cirrhosis (69%). Bleeding related to portal hypertension (30%) and severe sepsis (33%) were the most common reasons for admission. ICU and hospital mortality were respectively 65.9% and 70.3%. Prognostic severity scores, the need for other organ support therapy, infection, and total bilirubin value at ICU admission were significantly associated with ICU mortality. Eighty-four patients (34.1%) were discharged from the ICU. Among these patients, the one-year survival was only of 32%. Logistic regression analysis, using survival at one year as the endpoint, identified two independent risk factors: the length of ventilation (odds ratio [OR] = 1.1; 95% CI, 1.0-1.2; p = 0.02) and total bilirubin at ICU discharge (OR = 1.3; 95% CI, 1.1-1.5; p = 0.006).
  
  
  CONCLUSIONS
  Patients with cirrhosis admitted to the liver ICU and who required mechanical ventilation have a poor prognosis with a 1-year mortality of 89%. At ICU discharge, a total bilirubin level higher than 64.5 μmol/L and length of ventilation higher than 9 days could help the hepatologists to identify patients at risk of death in the year following the ICU discharge.
authors.affiliation: AP-HP Hôpital Henri Mondor, Anesthésie et Réanimations Chirurgicales, Créteil, France; AP-HP Hôpital Paul Brousse, Centre Hépato-Biliaire, Villejuif, France.
authors.forename: Eric
authors.initials: E
authors.lastname: Levesque
authors.affiliation: AP-HP Hôpital Paul Brousse, Centre Hépato-Biliaire, Villejuif, France; Univ Paris-Sud, UMR-S 785, Villejuif, France; Inserm, Unité 785, 94800 Villejuif, France. Electronic address: faouzi.saliba@pbr.aphp.fr.
authors.forename: Faouzi
authors.initials: F
authors.lastname: Saliba
authors.affiliation: AP-HP Hôpital Paul Brousse, Centre Hépato-Biliaire, Villejuif, France; Univ Paris-Sud, UMR-S 785, Villejuif, France; Inserm, Unité 785, 94800 Villejuif, France.
authors.forename: Philippe
authors.initials: P
authors.lastname: Ichaï
authors.affiliation: AP-HP Hôpital Paul Brousse, Centre Hépato-Biliaire, Villejuif, France; Univ Paris-Sud, UMR-S 785, Villejuif, France; Inserm, Unité 785, 94800 Villejuif, France.
authors.forename: Didier
authors.initials: D
authors.lastname: Samuel
mesh_terms: D000368:Aged; D002423:Cause of Death; D015331:Cohort Studies; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007362:Intensive Care Units; D008103:Liver Cirrhosis / Q000401:mortality / Q000628:therapy*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012121:Respiration, Artificial; D012720:Severity of Illness Index; D016896:Treatment Outcome
keywords: ACLF; AUROC; CFU; CLIF-SOFA; CRRT; Cirrhosis; ECMO; HIV; ICU; Intensive care unit; MARS; MCPIS; MELD; MELD-Na; Mechanical ventilation; Mortality; OR; Outcome; ROC; SAPS II; SIRS; SOFA; acute-on-chronic liver failure; areas under receiver operating characteristic; chronic liver failure – sequential organ failure assessment; colony forming units; continuous renal replacement therapy; extracorporeal membrane oxygenation; human immunodeficiency virus; intensive care unit; model for end-stage liver disease; model for end-stage liver disease with incorporation of serum sodium; modified clinical pulmonary infection score; molecular adsorbent recirculating system; odds ratio; receiver operating characteristic; sequential organ failure assessment; simplified acute physiology score; systemic inflammatory response syndrome