Does intubation really equal death in cirrhotic patients? Factors influencing outcome in patients with liver cirrhosis requiring mechanical ventilation

Rabe, Christian; Schmitz, Volker; Paashaus, Michael; Musch, Annemarie; Zickermann, Helga; Dumoulin, Franz Ludwig; Sauerbruch, Tilman; Caselmann, Wolfgang H.

doi:10.1007/s00134-004-2346-x

Cited by 78 publications

(82 citation statements)

References 29 publications

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“…Previous data have combined patients with sepsis, encephalopathy and variable proportion of variceal bleeders of 26-66%. 19,20,[22][23][24][25][35][36][37][38][39][40][41][42][43] ICU and HM rates in our cohort were 28% and 39%, respectively compared to 36-39% and 44-74%, respectively in a recent review of all cirrhotics admitted to ICU. 20 This may be attributed to improved prognosis of cirrhotic patients admitted to ICU with AVH.…”

Section: Discussionmentioning

confidence: 99%

Comparison of scoring systems and outcome of patients admitted to a liver intensive care unit of a tertiary referral centre with severe variceal bleeding

Al-Freah

Gera

Martini

et al. 2014

Aliment Pharmacol Ther

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Summary Background Acute variceal haemorrhage (AVH) is associated with significant mortality. Aims To determine outcome and factors associated with hospital mortality (HM) in patients with AVH admitted to intensive care unit (ICU) and to compare outcomes of patients requiring transfer to a tertiary ICU (transfer group, TG) to a local in‐patient group (LG). Methods A retrospective study of all adult patients (N = 177) admitted to ICU with AVH from 2000–2008 was performed. Results Median age was 48 years (16–80). Male represented 58%. Median MELD score was 16 (6–39), SOFA score was 8 (6–11). HM was higher in patients who had severe liver disease or critical illness measured by MELD, SOFA, APACHE II scores and number of failed organs (NFO), P < 0.05. Patients with day‐1 lactate ≥ 2 mmol/L had increased HM (P < 0.001). MELD score performed as well as APACHE II, SOFA and NFO (P < 0.001) in predicting HM (AUROC = 0.84, 0.81, 0.79 and 0.82, respectively P > 0.05 for pair wise comparisons). Re‐bleeding was associated with increased HM (56.9% vs. 31.6%, P = 0.002). The TG (n = 124) had less severe liver disease and critical illness and consequently had lower HM than local patients (32% vs. 57%, P = 0.002). TG patients with ≥2 endoscopies prior to transfer had increased 6‐week mortality (P = 0.03). Time from bleeding to transfer ≥3 days was associated with re‐bleeding (OR = 2.290, P = 0.043). Conclusions MELD score was comparable to ICU prognostic models in predicting mortality. Blood lactate was also predictive of hospital mortality. Delays in referrals and repeated endoscopy were associated with increased re‐bleeding and mortality in this group.

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Section: Discussionmentioning

confidence: 99%

Comparison of scoring systems and outcome of patients admitted to a liver intensive care unit of a tertiary referral centre with severe variceal bleeding

Al-Freah

Gera

Martini

et al. 2014

Aliment Pharmacol Ther

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“…Increased abdominal pressure due to ascites or atelectasis of the lung, due to hydrothorax, can facilitate the development of infections such as spontaneous bacterial peritonitis (SBP) or pneumonia, which, together with the increased risk of aspiration in the presence of hepatic encephalopathy (HE), might exacerbate to ACLF with a very poor prognosis [18][19][20][21]. However, the hemodynamic derangements in PHT might also predispose to ACLF.…”

Section: Portal Hypertension and Acute Decompensationmentioning

confidence: 99%

Gut-Liver Axis Links Portal Hypertension to Acute-on-Chronic Liver Failure

2018

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Acute-on-chronic liver failure (ACLF) is considered a distinct syndrome in patients with liver disease, with systemic inflammation playing a central role. Portal hypertension (PHT) is also aggravated by inflammation and may subsequently impact the course of ACLF. PHT is more than just an increase in portal pressure in the portal venous system; it aggravates the course of liver disease and, thus, also facilitates the development of acute decompensation and ACLF. A critical mechanistic link between PHT and ACLF might be the gut-liver axis, which is discussed in this review.

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“…La mortalité des malades cirrhotiques admis en réanimation, évaluée à partir d'une quinzaine d'études [3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18] (Tableau 1) correspondant au total à environ 2 500 malades, est de 45 % à l'issue du séjour en réanimation. Ce chiffre est en nette régression comparé aux données des années 1980 rapportant des mortalités en réanimation de plus de 80 % [23][24][25].…”

Section: Mortalité Du Patient Cirrhotique En Réanimationunclassified

“…Dans les études plus récentes, la mortalité des malades cirrhotiques ventilés artificiellement est un peu moins élevée, de 50 à 60 % [5,8,12,17,18]. L'existence d'une défaillance respiratoire n'est d'ailleurs pas toujours associée à une surmortalité [10].…”

Section: Facteurs Associés Au Pronostic Des Patients Cirrhotiques Admunclassified

“…La cirrhose est d'ailleurs intégrée en tant que telle au calcul du score Apache II (Acute Physiologic, Age and Chronic Health Evaluation), score d'évaluation de la gravité des patients largement utilisé en réanimation [2]. Cependant, dans les études récentes, la mortalité des patients cirrhotiques hospitalisés en réanimation paraissait moindre, aux alentours de 50 % [3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18]. Les objectifs de cette revue sont :…”

Section: Introductionunclassified

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Quel malade cirrhotique faut-il admettre en réanimation ?

Goudet¹,

Charier

Robert³

2011

Réanimation

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La proposition d'admission d'un patient cirrhotique en réanimation soulève fréquemment de la part des réanima-teurs des réticences, étant donné la forte probabilité de décès attribuée a priori à ces patients. Quel que soit le motif d'admission en réanimation (hémorragie digestive, encéphalopa-thie, infections bactériennes ou insuffisance rénale aiguë), les altérations du système immunitaire d'une part, et du système cardiocirculatoire d'autre part augmentent de façon importante le risque de défaillance multiviscérale chez ces malades. Ainsi, plusieurs études ont montré que la cirrhose était un facteur indépendant de mortalité chez le malade de réanimation. Dans les études actuelles, la mortalité des patients cirrhotiques admis en réanimation est d'environ 50 %, soit un chiffre plus élevé que les 15 à 20 % observés pour la population générale des patients de réanimation. Les objectifs de cette revue sont : 1) de déterminer les facteurs associés à la mortalité des patients cirrhotiques admis en réanimation ; 2) d'analyser la performance des scores « géné-ralistes » ou « hépatiques » pour prédire la mortalité de ces patients ; et 3) de tenter de sélectionner les patients les plus à même de bénéficier d'une hospitalisation en réanimation ou, au contraire, ceux pour lesquels une hospitalisation en réanimation paraît déraisonnable. Pour citer cette revue : Réanimation 20 (2011).Abstract The decision to admit a patient with severely decompensated cirrhosis to a general intensive care unit (ICU) may be a difficult one, because of the high risk of death. Whatever is the reason for ICU admission (including gastrointestinal hemorrhage, encephalopathy, sepsis, and acute renal failure), immune system alterations and hemodynamic failure significantly increase the risk of multiorgan failure. Consistently, several studies showed that cirrhosis was an independent risk factor of mortality in ICU patients. Recent studies reported a 50% mortality rate of cirrhotic patients admitted in the ICU, which is higher than the 15 to 20% overall mortality rate attributed to ICU patients. The aims of this review were: 1) to determine the factors related to mortality risk in cirrhotic patients admitted in the ICU; 2) to analyze the performance of the various generalist and hepatic scores to predict mortality; and 3) to try to select which cirrhotic patients should or not be admitted in the ICU. To cite this journal: Réanimation 20 (2011).

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Does intubation really equal death in cirrhotic patients? Factors influencing outcome in patients with liver cirrhosis requiring mechanical ventilation

Abstract: Markers of advanced chronic liver disease but not of the severity of acute illness are correlated to ICU outcome in ventilated cirrhotic patients. The outcome of advanced cases (Child-Pugh score of 12 and above) is poor.

Cited by 78 publications

References 29 publications

Comparison of scoring systems and outcome of patients admitted to a liver intensive care unit of a tertiary referral centre with severe variceal bleeding

Comparison of scoring systems and outcome of patients admitted to a liver intensive care unit of a tertiary referral centre with severe variceal bleeding

Gut-Liver Axis Links Portal Hypertension to Acute-on-Chronic Liver Failure

Quel malade cirrhotique faut-il admettre en réanimation ?

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