title: [Evaluation and treatment of the critically ill cirrhotic patient].
abstract: Cirrhotic patients often develop severe complications requiring ICU admission. Grade III-IV hepatic encephalopathy, septic shock, acute-on-chronic liver failure and variceal bleeding are clinical decompensations that need a specific therapeutic approach in cirrhosis. The increased effectiveness of the treatments currently used in this setting and the spread of liver transplantation programs have substantially improved the prognosis of critically ill cirrhotic patients, which has facilitated their admission to critical care units. However, gastroenterologists and intensivists have limited knowledge of the pathogenesis, diagnosis and treatment of these complications and of the prognostic evaluation of critically ill cirrhotic patients. Cirrhotic patients present alterations in systemic and splanchnic hemodynamics, coagulation and immune dysfunction what further increase the complexity of the treatment, the risk of developing new complications and mortality in comparison with the general population. These differential characteristics have important diagnostic and therapeutic implications that must be known by general intensivists. In this context, the Catalan Society of Gastroenterology and Hepatology requested a group of experts to draft a position paper on the assessment and treatment of critically ill cirrhotic patients. This article describes the recommendations agreed upon at the consensus meetings and their main conclusions.
authors.affiliation: Liver Unit, Hospital Clínic, Universitat de Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer, CIBERehd, Barcelona, España.
authors.forename: Javier
authors.initials: J
authors.lastname: Fernández
authors.affiliation: Servei de Digestiu, Hospital Universitari Arnau de Villanova, Lleida, España.
authors.forename: Carles
authors.initials: C
authors.lastname: Aracil
authors.affiliation: Liver Unit, Hospital Clínic, Universitat de Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer, CIBERehd, Barcelona, España.
authors.forename: Elsa
authors.initials: E
authors.lastname: Solà
authors.affiliation: Servicio de Patología Digestiva, Hospital de la Santa Creu i Sant Pau. CIBERehd, Instituto de Salud Carlos III, Barcelona, España.
authors.forename: Germán
authors.initials: G
authors.lastname: Soriano
authors.affiliation: Servicio de Digestivo, Hospital de Tortosa Verge de la Cinta, Tortosa, Tarragona, España.
authors.forename: Maria
authors.initials: M
authors.lastname: Cinta Cardona
authors.affiliation: Servicio de Digestivo, Hospital del Mar, Barcelona, España.
authors.forename: Susanna
authors.initials: S
authors.lastname: Coll
authors.affiliation: Servicio de Medicina Interna-Hepatología, Hospital Universitari Vall d'Hebron, Institut de Recerca Vall d'Hebron (VHIR), Universidad Autónoma de Barcelona CIBERehd, Barcelona, España.
authors.forename: Joan
authors.initials: J
authors.lastname: Genescà
authors.affiliation: Servicio de Aparato Digestivo, Hospital Dr. Josep Trueta, Facultat de Medicina, Universitat de Girona, Girona, España.
authors.forename: Manoli
authors.initials: M
authors.lastname: Hombrados
authors.affiliation: Servicio de Hepatología, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, España.
authors.forename: Rosa
authors.initials: R
authors.lastname: Morillas
authors.affiliation: Servei de Digestiu, Hospital de Sant Joan Despí Moisès Broggi, Sant Joan Despí, Barcelona, España.
authors.forename: Marta
authors.initials: M
authors.lastname: Martín-Llahí
authors.affiliation: Servicio de Aparato Digestivo, Hospital Universitari de Tarragona Joan XXIII, Tarragona, España.
authors.forename: Albert
authors.initials: A
authors.lastname: Pardo
authors.affiliation: Corporació Sanitària Parc Taulí, Sabadell. CIBERehd, Instituto de Salud Carlos III, Sabadell, Barcelona, España.
authors.forename: Jordi
authors.initials: J
authors.lastname: Sánchez
authors.affiliation: Servicio de Medicina Interna-Hepatología, Hospital Universitari Vall d'Hebron, Institut de Recerca Vall d'Hebron (VHIR), Universidad Autónoma de Barcelona CIBERehd, Barcelona, España.
authors.forename: Victor
authors.initials: V
authors.lastname: Vargas
authors.affiliation: Servicio de Aparato Digestivo, Hospital Universitari de Bellvitge, Hospitalet de Llobregat, Barcelona, España.
authors.forename: Xavier
authors.initials: X
authors.lastname: Xiol
authors.affiliation: Liver Unit, Hospital Clínic, Universitat de Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer, CIBERehd, Barcelona, España. Electronic address: pgines@clinic.cat.
authors.forename: Pere
authors.initials: P
authors.lastname: Ginès
mesh_terms: D058186:Acute Kidney Injury / Q000209:etiology; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001778:Blood Coagulation Disorders / Q000209:etiology; D003131:Combined Modality Therapy; D003422:Critical Care / Q000379:methods; D016638:Critical Illness; D019468:Disease Management; D042241:Early Diagnosis; D004932:Esophageal and Gastric Varices / Q000209:etiology / Q000628:therapy; D005440:Fluid Therapy; D006471:Gastrointestinal Hemorrhage / Q000209:etiology / Q000628:therapy; D006489:Hemostatic Techniques; D006501:Hepatic Encephalopathy / Q000209:etiology / Q000628:therapy; D006801:Humans; D008103:Liver Cirrhosis / Q000150:complications / Q000628:therapy*; D017093:Liver Failure / Q000209:etiology / Q000628:therapy; D016031:Liver Transplantation; D012121:Respiration, Artificial; D012772:Shock, Septic / Q000209:etiology / Q000628:therapy
chemical_list: D000900:Anti-Bacterial Agents
keywords: Acute kidney injury; Acute-on-chronic liver failure; Encefalopatía hepática; Fracaso hepático agudo sobre crónico; Hemorragia variceal; Hepatic encephalopathy; Insuficiencia renal; Prognosis; Pronóstico; Sepsis grave; Severe sepsis; Variceal bleeding