Citation

Cruz JPS, Punjabi C, Lippmann M. Clin. Pulm. Med. 2016; 23(6): 252-257.

Copyright

(Copyright © 2016, Wolters Kluwer)

DOI

10.1097/CPM.0000000000000169

PMID

unavailable

Abstract

BACKGROUND: Aggressive treatment of mechanically ventilated liver failure patients has been questioned as they frequently succumb to multiorgan failure. However, survivors have a chance at liver transplantation, and the knowledge of mortality predictors may help decrease the wait-list mortality. We aimed to determine outcomes of this population and determine which variables predict mortality.

MATERIALS AND METHODS: A retrospective study of 131 mechanically ventilated liver failure patients admitted to the intensive care unit (ICU) of a major liver transplant center from January 2011 to June 2014 with a follow-up period of 1 year.

RESULTS: The most common indication for ICU admission and intubation was hepatic encephalopathy. The median length of intubation was 4 days. Patients intubated for miscellaneous reasons spent the longest time on mechanical ventilation at a median of 12 days followed by sepsis and respiratory failure. In-hospital and 1-year mortalities were 54% and 71%, respectively. Only 5 of 27 patients listed for transplant received an organ. Patients readmitted to the ICU were 4 times more likely to die in 1 year. A Model for End Stage Liver Disease (MELD) score >40 and chronic kidney disease were the strongest predictors for overall mortality. A MELD score >40 was the sole predictor for in-hospital mortality. Acute renal failure, ICU readmission, and hepatic encephalopathy were additional predictors for postdischarge mortality.

CONCLUSIONS: The in-hospital mortality remains as high at 54%. The MELD score was consistently a predictor for overall, in-hospital, and postdischarge mortalities. Patients readmitted to the ICU were 4 times more likely to die in 1 year. Most survivors who were liver transplant candidates died waiting for an organ. Copyright © 2016 Wolters Kluwer Health, Inc. All rights reserved.

Language: en

Keywords

adult; human; female; male; liver failure; acute lung injury; mortality; suicide attempt; disease severity; liver transplantation; alcohol consumption; major clinical study; retrospective study; hospital admission; length of stay; middle aged; intensive care unit; paracetamol; albumin; albumin blood level; sepsis; follow up; cross-sectional study; acute kidney failure; fever; artificial ventilation; congestive heart failure; lung disease; liver injury; chronic obstructive lung disease; creatinine; creatinine blood level; respiratory failure; epileptic state; metabolic acidosis; liver cirrhosis; hepatic encephalopathy; disseminated intravascular clotting; gastrointestinal hemorrhage; leukocytosis; nephrolithiasis; positive end expiratory pressure; diclofenac; virus hepatitis; Article; hemoglobin; fresh frozen plasma; outcome assessment; bilirubin; bilirubin blood level; hospital readmission; delirium tremens; hemoglobin blood level; epistaxis; erythrocyte transfusion; sputum culture; ICU; hemoperitoneum; hydrothorax; chronic kidney disease; cardiopulmonary insufficiency; ventilator associated pneumonia; hepatorenal syndrome; acute liver failure; mortality rate; ventilated patient; hospital mortality; bacterial peritonitis; chronic liver failure; end-stage liver disease; gas exchange; hepatic failure; hepatopulmonary syndrome; mechanical ventilation; Model For End Stage Liver Disease Score; paracentesis; tracheal aspiration procedure; tracheobronchitis