Long-term outcome of patients with liver cirrhosis admitted to a general intensive care unit

Alex Warren; Charlotte R Soulsby; Alex Puxty; Joseph Campbell; Martin Shaw; Tara Quasim; John Kinsella; Joanne McPeake

doi:10.1186/s13613-017-0257-6

Long-term outcome of patients with liver cirrhosis admitted to a general intensive care unit

Ann Intensive Care. 2017 Dec;7(1):37. doi: 10.1186/s13613-017-0257-6. Epub 2017 Apr 4.

Authors

Alex Warren¹, Charlotte R Soulsby¹, Alex Puxty², Joseph Campbell¹, Martin Shaw³, Tara Quasim^{1

2}, John Kinsella¹, Joanne McPeake^{4

5}

Affiliations

¹ 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.
² Intensive Care Unit, NHS Greater Glasgow and Clyde, 84 Castle Street, Glasgow, Scotland, G4 OSF, UK.
³ Medical Physics, NHS Greater Glasgow and Clyde, Level 2, New Lister Building, Glasgow Royal Infirmary, 10-16 Alexandra Parade, Glasgow, Scotland, G31 2ER, UK.
⁴ 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.
⁵ Intensive Care Unit, NHS Greater Glasgow and Clyde, 84 Castle Street, Glasgow, Scotland, G4 OSF, UK. joanne.mcpeake@glasgow.ac.uk.

Abstract

Objectives: 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.

Design: Observational cohort study.

Setting: General adult critical care unit in a UK teaching hospital.

Patients: Eighty-four patients admitted to critical care between June 2012 and December 2013.

Primary outcome measures: 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.

Keywords: Child–Pugh; Cirrhosis; Critical care; Lactate; Scoring tools.