title: Long-term outcome of patients with liver cirrhosis admitted to a general intensive care unit.
abstract: OBJECTIVE
  The prevalence of liver cirrhosis is increasing, and many patients have acute conditions requiring consideration of intensive care. This study aims to: (a) report the outcome at 12 months of patients with cirrhosis admitted to ICU, (b) identify factors predictive of long-term mortality and (c) evaluate the ability of scoring systems to predict long-term outcome.
  
  
  METHODS
  Observational cohort study.
  
  
  METHODS
  General adult critical care unit in a UK teaching hospital.
  
  
  METHODS
  Eighty-four patients admitted to critical care between June 2012 and December 2013.
  
  
  METHODS
  Cumulative survival at ICU discharge, hospital discharge and 12 months.
  
  
  RESULTS
  Eighty-four patients with diagnosed cirrhosis were followed up at 12 months. Clinical variables collected at ICU admission were entered into a multivariate regression analysis for mortality and eight predetermined scoring systems calculated. Cumulative survival at ICU discharge, hospital discharge and 12 months was 64.8, 47.1 and 44.1%, respectively. Twelve months of cumulative survival in patients with Child-Pugh class A was 100%, class B was 50% and class C was 25% (log rank p = 0.002). Independent predictors of mortality at 12 months were lactate, bilirubin, PT ratio and age. The Child-Pugh + Lactate score was modified to produce an objective score comprising Albumin, Bilirubin and Clotting (PT ratio) added to serum lactate concentration in mmol L-1(ABC + Lactate). This score was the best predictor of 12-month survival, with an AUC of 0.83. A proposed classification by ABC + Lactate score was highly significant (p = 0.001), with those in the highest class having ICU mortality of 75% and hospital and 12-month mortality of 93%.
  
  
  CONCLUSIONS
  Patients with cirrhosis admitted to ICU have high initial mortality but low mortality after hospital discharge. Child-Pugh class at ICU admission predicts outcome at 12 months. The ABC + Lactate classification system may be useful in identifying critically ill cirrhotic patients with very high long-term mortality.
authors.affiliation: Academic Unit of Anaesthesia, Pain and Critical Care, University of Glasgow, Room 2.73, Level 2, New Lister Building, Glasgow Royal Infirmary, 10-16 Alexandra Parade, Glasgow, Scotland, G31 2ER, UK.
authors.forename: Alex
authors.initials: A
authors.lastname: Warren
authors.affiliation: Academic Unit of Anaesthesia, Pain and Critical Care, University of Glasgow, Room 2.73, Level 2, New Lister Building, Glasgow Royal Infirmary, 10-16 Alexandra Parade, Glasgow, Scotland, G31 2ER, UK.
authors.forename: Charlotte R
authors.initials: CR
authors.lastname: Soulsby
authors.affiliation: Intensive Care Unit, NHS Greater Glasgow and Clyde, 84 Castle Street, Glasgow, Scotland, G4 OSF, UK.
authors.forename: Alex
authors.initials: A
authors.lastname: Puxty
authors.affiliation: Academic Unit of Anaesthesia, Pain and Critical Care, University of Glasgow, Room 2.73, Level 2, New Lister Building, Glasgow Royal Infirmary, 10-16 Alexandra Parade, Glasgow, Scotland, G31 2ER, UK.
authors.forename: Joseph
authors.initials: J
authors.lastname: Campbell
authors.affiliation: Medical Physics, NHS Greater Glasgow and Clyde, Level 2, New Lister Building, Glasgow Royal Infirmary, 10-16 Alexandra Parade, Glasgow, Scotland, G31 2ER, UK.
authors.forename: Martin
authors.initials: M
authors.lastname: Shaw
authors.affiliation: Academic Unit of Anaesthesia, Pain and Critical Care, University of Glasgow, Room 2.73, Level 2, New Lister Building, Glasgow Royal Infirmary, 10-16 Alexandra Parade, Glasgow, Scotland, G31 2ER, UK.|Intensive Care Unit, NHS Greater Glasgow and Clyde, 84 Castle Street, Glasgow, Scotland, G4 OSF, UK.
authors.forename: Tara
authors.initials: T
authors.lastname: Quasim
authors.affiliation: Academic Unit of Anaesthesia, Pain and Critical Care, University of Glasgow, Room 2.73, Level 2, New Lister Building, Glasgow Royal Infirmary, 10-16 Alexandra Parade, Glasgow, Scotland, G31 2ER, UK.
authors.forename: John
authors.initials: J
authors.lastname: Kinsella
authors.affiliation: Academic Unit of Anaesthesia, Pain and Critical Care, University of Glasgow, Room 2.73, Level 2, New Lister Building, Glasgow Royal Infirmary, 10-16 Alexandra Parade, Glasgow, Scotland, G31 2ER, UK. joanne.mcpeake@glasgow.ac.uk.|Intensive Care Unit, NHS Greater Glasgow and Clyde, 84 Castle Street, Glasgow, Scotland, G4 OSF, UK. joanne.mcpeake@glasgow.ac.uk.
authors.forename: Joanne
authors.initials: J
authors.lastname: McPeake
keywords: Child–Pugh; Cirrhosis; Critical care; Lactate; Scoring tools