@article{ref1,
title="The effect of cirrhosis on trauma outcomes: a systematic review and meta-analysis",
journal="Journal of trauma and acute care surgery",
year="2019",
author="Serrano, Elina and Liu, Pingyang and Nwabuo, Adaobi I. and Langness, Simone and Juillard, Catherine",
volume="ePub",
number="ePub",
pages="ePub-ePub",
abstract="BACKGROUND: The negative effect of cirrhosis on mortality following traumatic injury has been quantified in multiple observational studies. However, to our knowledge, the information contained in these studies has never been synthesized. The aims of this study were: 1) to determine the magnitude of the effect of liver cirrhosis on mortality, morbidity and hospital course among trauma patients and 2) to analyze sources of study heterogeneity that may lead to differing estimates in the observed mortality rate among patients with cirrhosis. <br><br>METHODS: A systematic search of EMBASE and PubMed was conducted. Data were extracted from eligible studies and analyzed using a random-effects model to compare trauma outcomes in cirrhotic and non-cirrhotic patients (PROSPERO Registration CRD42018088464). Mortality was the primary outcome. Secondary outcomes included complication rate, length of hospital stay, length of intensive care unit stay, and mechanical ventilation days. <br><br>RESULTS: Title and abstract review of 15,958 articles led to the identification of 31 relevant articles. Ultimately, eighteen observational studies were included in this meta-analysis. The pooled effect sizes for mortality (OR 4.52; 95% CI 3.13-6.54) and complication rate (OR 1.92; 95% CI 1.30-2.85) were higher in the cirrhotic group than the non-cirrhotic group. Trauma patients with cirrhosis also incurred longer hospital stays (MD 3.81 days; 95% CI 1.22-6.41) and longer ICU stays (MD 2.40 days; 95% CI 0.65-4.15). There was no difference in days spent on mechanical ventilation.<br><br>CONCLUSIONPre-existing liver cirrhosis is associated with increased mortality rate, complication rate, and length of hospitalization among trauma patients, even after adjusting for confounding factors and potential sources of between-study heterogeneity. Trauma patients with cirrhosis would benefit from heightened surveillance and injury prevention interventions.LEVEL OF EVIDENCESystematic review and meta-analysis, Level III.<p /> <p>Language: en</p>",
language="en",
issn="2163-0755",
doi="10.1097/TA.0000000000002464",
url="http://dx.doi.org/10.1097/TA.0000000000002464"
}