title: Liver Cirrhosis is Independently Associated With 90-Day Mortality in ARDS Patients.
abstract: BACKGROUND
  In a few studies, cirrhosis has been associated with increased mortality in patients with acute respiratory distress syndrome (ARDS). These studies were, however, conducted mostly before 2000. Over the last 15 years, the prognosis of cirrhotic patients admitted to the intensive care unit (ICU) seems to have improved and major changes in the management of mechanical ventilation (MV) of ARDS have appeared. The aim of this study was to determine whether cirrhosis remains a factor for poor prognosis despite improvements in MV techniques and supportive therapies for ARDS.
  
  
  METHODS
  Retrospective analysis of data recorded from 232 patients (42 with cirrhosis and 290 without cirrhosis) who received lung-protective ventilation for ARDS defined according to American-European Consensus Conference criteria and admitted from 2006 to 2013. Alcohol was the most common aetiology of the cirrhosis. The end point was mortality at day-90 from the diagnosis of ARDS, survival was calculated using the Kaplan-Meier method, and we used a Cox-proportional hazard model to determine whether cirrhosis remained independently associated with mortality after adjustment for other prognostic variables for ARDS described previously. Organ dysfunctions were assessed based on the Sequential Organ Failure Assessment (SOFA) criteria, pulmonary and nonpulmonary dysfunctions were distinguished and compared between cirrhotic and non-cirrhotic patients on the first 3 days of VM.
  
  
  RESULTS
  Comparison of survival curves showed that cirrhotic patients had a poorer 90-day prognosis than non-cirrhotic patients (P = 0.03 by the log-rank test). After adjusted analysis, cirrhosis remained independently associated with mortality at day 90 (adjusted hazard ratio 2.09, 95% CI, 1.27-3.45, P = 0.004). Non-pulmonary SOFA scores were significantly higher in cirrhotic patients than in non-cirrhotic patients on day 1 (P < 0.001), day 2 (P = 0.003), and day 3 (P = 0.002) of MV for ARDS whereas pulmonary SOFA scores did not differ significantly.
  
  
  CONCLUSIONS
  Despite improvements in the management of cirrhotic patients admitted to the ICU and in the management of MV for the treatment of ARDS, cirrhosis remained associated with a poorer prognosis in ARDS patients. The prognosis of cirrhotic patients with ARDS appears related to extrapulmonary organ dysfunctions rather than pulmonary dysfunction.
authors.affiliation: *Infectious Diseases and Intensive Care Unit, Rennes University Hospital †Faculty of Medicine, Rennes 1 University, Biosit ‡Inserm-CIC-1414, Faculty of Medicine, Rennes 1 University, IFR 140, Rennes, France.
authors.forename: Arnaud
authors.initials: A
authors.lastname: Gacouin
authors.forename: Maxime
authors.initials: M
authors.lastname: Locufier
authors.forename: Fabrice
authors.initials: F
authors.lastname: Uhel
authors.forename: Julien
authors.initials: J
authors.lastname: Letheulle
authors.forename: Pierre
authors.initials: P
authors.lastname: Bouju
authors.forename: Pierre
authors.initials: P
authors.lastname: Fillatre
authors.forename: Yves
authors.initials: Y
authors.lastname: Le Tulzo
authors.forename: Jean Marc
authors.initials: JM
authors.lastname: Tadié
mesh_terms: D000328:Adult; D000368:Aged; D002423:Cause of Death; D005260:Female; D005602:France / Q000453:epidemiology; D006801:Humans; D007362:Intensive Care Units; D008103:Liver Cirrhosis / Q000150:complications / Q000401:mortality*; D008297:Male; D008875:Middle Aged; D010100:Oxygen / Q000097:blood; D010313:Partial Pressure; D011175:Positive-Pressure Respiration / Q000379:methods; D011379:Prognosis; D012128:Respiratory Distress Syndrome / Q000150:complications / Q000175:diagnosis / Q000401:mortality* / Q000628:therapy; D012189:Retrospective Studies; D012720:Severity of Illness Index
chemical_list: D010100:Oxygen