title: Cirrhosis increases mortality and splenectomy rates following splenic injury.
abstract: BACKGROUND
  Cirrhosis may be a risk factor for mortality following blunt splenic injury (BSI) and it predicts the need for an operative intervention.
  
  
  METHODS
  We performed a case-control study at 3 level 1 trauma centers. Comparisons were made with chi-square test, Wilcoxon rank-sum test, and binary logistic regression, and stratified by propensity for splenectomy. Data are presented as odds ratios (ORs) and 95% confidence intervals (95% CIs).
  
  
  RESULTS
  Mortality was 27% (21/77) and cirrhosis was a strong risk factor for death (OR 8.8, 95% CI 3.7 to 21.1). Compared with controls, cirrhosis was an independent risk factor for splenectomy (OR 5.4, 95% CI 2.5 to 11.5), and only splenic injury grade was associated with splenectomy (OR 2.2, 95% CI 1.3 to 3.6). Only admission model for end-stage liver disease was independently associated with mortality after an operation (OR 1.7, 95% CI 1.1 to 2.8). After propensity score matching, we found no association between splenectomy and mortality in cirrhotic patients.
  
  
  CONCLUSIONS
  Cirrhosis dramatically increases mortality and the odds of an operative intervention in BSI patients with pre-existing cirrhosis, and BSI requires vigilant attention and early intervention should be considered.
authors.affiliation: Division of Trauma, Critical Care and Acute Surgery, Oregon Health and Science University, 3181 SW Sam Jackson Park Road, Portland, OR 97239, USA. Electronic address: cookmac@ohsu.edu.
authors.forename: Mackenzie R
authors.initials: MR
authors.lastname: Cook
authors.affiliation: Division of Trauma, Critical Care and Acute Surgery, Oregon Health and Science University, 3181 SW Sam Jackson Park Road, Portland, OR 97239, USA.
authors.forename: Kelly A
authors.initials: KA
authors.lastname: Fair
authors.affiliation: Division of Trauma, Critical Care and Acute Surgery, Oregon Health and Science University, 3181 SW Sam Jackson Park Road, Portland, OR 97239, USA.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Burg
authors.affiliation: Division of Trauma, Burns and Critical Care, Harborview Medical Center, Seattle, WA, USA.
authors.forename: Lindsay
authors.initials: L
authors.lastname: Cattin
authors.affiliation: Pacific Surgical, Legacy Emanuel Medical Center, Portland, OR, USA.
authors.forename: Arvin
authors.initials: A
authors.lastname: Gee
authors.affiliation: Division of Trauma, Burns and Critical Care, Harborview Medical Center, Seattle, WA, USA.
authors.forename: Saman
authors.initials: S
authors.lastname: Arbabi
authors.affiliation: Division of Trauma, Critical Care and Acute Surgery, Oregon Health and Science University, 3181 SW Sam Jackson Park Road, Portland, OR 97239, USA.
authors.forename: Martin
authors.initials: M
authors.lastname: Schreiber
mesh_terms: D000007:Abdominal Injuries / Q000150:complications* / Q000401:mortality / Q000601:surgery; D000328:Adult; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008103:Liver Cirrhosis / Q000209:etiology* / Q000401:mortality; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D013154:Spleen / Q000293:injuries* / Q000601:surgery; D013156:Splenectomy / Q000639:trends*; D015996:Survival Rate / Q000639:trends; D014481:United States / Q000453:epidemiology; D014949:Wounds, Nonpenetrating / Q000150:complications* / Q000401:mortality / Q000601:surgery
keywords: Abdominal trauma; Blunt splenic injury; Cirrhosis; Nonoperative management