Cirrhosis and Trauma: A Deadly Duo

Abstract

It has been previously reported that trauma patients with cirrhosis undergoing emergency abdominal operations exhibit a fourfold increase in mortality independent of their Child's classification. We undertook this review to assess the impact of cirrhosis on trauma patients. We reviewed the records of patients from 1993 to 2003 with documented hepatic cirrhosis and compared them to a 2:1 control population without hepatic cirrhosis and matched for age, sex, Injury Severity Score (ISS), and Glasgow Coma Score (GCS). Demographic, severity of injury, and outcome data were recorded. Student's t test and χ2 were used for statistical analysis and a P < 0.05 was significant. Sixty-one patients had documented cirrhosis and were compared to 156 matched controls. Comparing the two groups demonstrates there was no difference in age, ISS, or GCS. Intensive care stay, hospital length of stay, blood requirements in the first 24 hours postinjury, and mortality (33% vs 1%) was significantly greater in the trauma patients with cirrhosis. Fifty-five per cent of deaths in the cirrhosis group was due to sepsis, and, as the Child's class increases, so does the mortality (Child's A, 15%; B, 37%; and C, 63%). In 64 per cent of cirrhotics without an emergent abdominal operation, mortality was 21 per cent. In the 36 per cent of cirrhotics who had emergent abdominal operation, mortality was 55 per cent. Hepatic cirrhosis in trauma patients, regardless of severity of injury or the need for an abdominal intervention, is a poor prognostic indicator. The necessity of an abdominal operative intervention further amplifies this effect. Trauma and cirrhosis is, in fact, a deadly duo.

Brain surgery in patients with liver cirrhosis

“…Christmas et al 4 and Garrison et al 9 reported a stepwise increase in the mortality rate with increasing Child class, increasing from 15% to 30% in Class A and from 63% to 82% in Class C in trauma patients who underwent laparotomy. In cardiac surgery, as reported by Thielmann et al, 26 the frequency of 1-year survival when taking into account the Child classification was 67.9% in Class A and 26.8% in Class B, but all patients in Class C died during the 30-day in-hospital period.…”

“…Although cirrhosis is a well-known risk factor for morbidity and mortality in patients undergoing surgery, 4,5,[8][9][10]27,29 few studies have reported the impact on outcomes after brain surgery in patients with cirrhosis. In previous studies, a high rate of surgery-related mortality (ranging from 22% to 33%) was reported in patients with liver cirrhosis.…”

One-Year Mortality after Traumatic Brain Injury in Liver Cirrhosis Patients—A Ten-Year Population-Based Study

“… 4 , 5 , 7 – 11 Compared with elective surgery, emergency surgery was associated with a significantly higher mortality in LC patients. 4 , 5 , 8 In Western society, alcohol consumption and hepatitis C are the most important causes of LC; 12 , 13 however, in Taiwan, most LC cases result from nonalcoholic etiologies, particularly hepatitis B. 14 …”

Cirrhosis increases complication rate and overall mortality in patients with traumatic lung injury

“…42 Survivors were compared to nonsurvivors and there was no difference in mean MELD scores, but the mean CTP score was higher in nonsurvivors (9.4 versus 7.7, p ¼ 0.001). Similarly, Christmas et al 14 found a stepwise increase in mortality in trauma patients with increasing Childs class starting from 15% in class A to 63% in Class C. The NTDB does not report the variables required to calculate MELD or CTP, which is a significant limitation of this study. That said, our overall mortality of 20.6% for all classes of cirrhotics combined appears consistent with these previous smaller reports.…”

“…13 However, they did not study the effects of cirrhosis which has previously been demonstrated to be a poor prognostic indicator in trauma patients. 14 We sought to better elucidate the interplay between cirrhosis and TLI and hypothesized that patients with TLI and cirrhosis have higher morbidity and mortality compared to patients without cirrhosis.…”