Increased survival of cirrhotic patients with septic shock

Abstract

IntroductionThe overall outcome of septic shock has been recently improved. We sought to determine whether this survival gain extends to the high-risk subgroup of patients with cirrhosis.MethodsCirrhotic patients with septic shock admitted to a medical intensive care unit (ICU) during two consecutive periods (1997-2004 and 2005-2010) were retrospectively studied.ResultsForty-seven and 42 cirrhotic patients presented with septic shock in 1997-2004 and 2005-2010, respectively. The recent period differed from the previous one by implementation of adjuvant treatments of septic shock including albumin infusion as fluid volume therapy, low-dose glucocorticoids, and intensive insulin therapy. ICU and hospital survival markedly improved over time (40% in 2005-2010 vs. 17% in 1997-2004, P = 0.02 and 29% in 2005-2010 vs. 6% in 1997-2004, P = 0.009, respectively). Furthermore, this survival gain in the latter period was sustained for 6 months (survival rate 24% in 2005-2010 vs. 6% in 1997-2004, P = 0.06). After adjustment with age, the liver disease stage (Child-Pugh score), and the critical illness severity score (SOFA score), ICU admission between 2005 and 2010 remained an independent favorable prognostic factor (odds ratio (OR) 0.09, 95% confidence interval (CI) 0.02-0.4, P = 0.004). The stage of the underlying liver disease was also independently associated with hospital mortality (Child-Pugh score: OR 1.42 per point, 95% CI 1.06-1.9, P = 0.018).ConclusionsIn the light of advances in management of both cirrhosis and septic shock, survival of such patients substantially increased over recent years. The stage of the underlying liver disease and the related therapeutic options should be included in the decision-making process for ICU admission.

Prognosis of cirrhotic patients admitted to intensive care unit: a meta-analysis

“…Finally, we received 11 answers, covering 13 studies (2523 patients, Table 1; Additional file 1: Figure S1) [2, 3, 5–8, 10, 35–40]. Studies from Jenq et al [37, 38] and from Levesque et al [2, 3] were grouped for avoiding double-counting patients in the meta-analyses.…”

Editorial: sepsis in cirrhosis – there may be trouble ahead

“…4 Simi-larly there is evidence that the survival of cirrhotic patients with cirrhosis is improving in the critical care environment. 5 Clearly, such changes are to be welcomed. However, although the overall mortality from sepsis may be falling, the types of infection encountered may reflect this more aggressive medical management.…”

“…However, we did not report these data as the prevalence rates were surprisingly low at 0.1-0.12%, 0.5-0.7%, and 0.01-0.05% for CAUTI, CLABSI and VAP, respectively, in contrast to much higher prevalence as reported recently in a prospective cohort study. 5 We believe that this is probably due to combination of under-reporting of these nosocomial infections by the respective hospitals and coding error since the 'no-pay rule' to claim additional payments for treating Hospital In-patient Infections from Centers for Medicare and Medicaid services was passed only in 2008. 6 Infections in cirrhotics will continue to be a major problem.…”

Exploration of skin perfusion in cirrhotic patients with septic shock

“…Cirrhosis has been identified as an independent risk factor of mortality in patients with septic shock (odds ratio (OR) = 2.5 [2.3; 2.8]) [5]. Despite improved outcome of patients with cirrhosis and septic shock during the last years, their mortality remains around 65% [5][6][7].…”