title: Predicting mortality of patients with cirrhosis admitted to medical intensive care unit: An experience of a single tertiary center.
abstract: OBJECTIVE
  Prognosis for patients with cirrhosis admitted to a medical intensive care unit (MICU) is poor and no previous studies have been published from Qatar or other countries in the region to investigate this issue. The objective of this study was to assess the predictors for in-hospital mortality and admission of cirrhotic patients to MICU in a single tertiary hospital in Qatar.
  
  
  METHODS
  All adult cirrhotic MICU patients hospitalized from 2007 through 2012 to Hamad General Hospital-Qatar were included. We compared them to cirrhotic patients admitted to medical wards during same period of time. All data were recorded and analyzed with respect to demographic parameters, clinical features and laboratory as well as radiology characteristics on day one of admission to MICU. Cirrhosis diagnosis was established either with a liver biopsy or the combination of physical, laboratory and radiologic findings. Predictors of mortality were defined by logistic regression analysis.
  
  
  RESULTS
  The cohort comprised 109 cirrhotic MICU patients (86.2% males), and their mean age±SD was 51.6±11.5. MICU-cirrhotic patients had longer hospital stays than medical wards-cirrhotic patients (p=0.01). Admission with severe hepatic encephalopathy, upper gastrointestinal bleeding and SOFA (Sepsis Related Organ Failure Assessment) score were the independent predicting factors for MICU admission. Mortality was higher for the MICU-cirrhotic group than medical wards group (27 (24.8%) deaths vs. 12 (5.3%) deaths, respectively, p=0.001). In multivariate logistic regression analyses, older age>60years (p=0.04), APACH-II score (p=0.001) and MELD score (p=0.02) were independent predicting factors for overall mortality.
  
  
  CONCLUSIONS
  Severe hepatic encephalopathy, upper gastrointestinal bleeding and SOFA score predict MICU admission of cirrhotic patients. Among MICU cirrhotic patients, older age, APACH-II score and MELD score predict mortality.
authors.affiliation: Department of Medicine, Hamad General Hospital, Qatar; Weill Cornell Medical College, Qatar. Electronic address: nelzouki_1999@yahoo.com.
authors.forename: Abdel-Naser
authors.initials: AN
authors.lastname: Elzouki
authors.affiliation: Department of Medicine, Hamad General Hospital, Qatar.
authors.forename: Shireen
authors.initials: S
authors.lastname: Suliman
authors.affiliation: Department of Medicine, Hamad General Hospital, Qatar.
authors.forename: Rania
authors.initials: R
authors.lastname: Alhasan
authors.affiliation: Department of Medicine, Hamad General Hospital, Qatar.
authors.forename: Ali
authors.initials: A
authors.lastname: Abdullah
authors.affiliation: Department of Medicine, Hamad General Hospital, Qatar.
authors.forename: Muftah
authors.initials: M
authors.lastname: Othman
authors.affiliation: Department of Medicine, Alkhor Hospital, Hamad Medical Corporation, Qatar.
authors.forename: Ahmad
authors.initials: A
authors.lastname: Badi
mesh_terms: D018806:APACHE; D000328:Adult; D000367:Age Factors; D058625:End Stage Liver Disease / Q000209:etiology; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000209:etiology*; D006501:Hepatic Encephalopathy / Q000209:etiology; D017052:Hospital Mortality; D006801:Humans; D007362:Intensive Care Units; D008103:Liver Cirrhosis / Q000150:complications* / Q000401:mortality*; D008297:Male; D008875:Middle Aged; D063305:Organ Dysfunction Scores; D011780:Qatar / Q000453:epidemiology; D012307:Risk Factors; D018805:Sepsis / Q000150:complications; D062606:Tertiary Care Centers
keywords: Cirrhosis; Medical intensive care; Mortality; Qatar; Score systems