Mortality of Patients with Alcoholic Liver Disease Admitted to Critical Care: A Systematic Review

Flood, Simon; Bodenham, Andrew; Jackson, Philippa

doi:10.1177/175114371201300210

Cited by 5 publications

(7 citation statements)

References 23 publications

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“…This compares favourably to the literature in which a weighted ICU mortality of 45% has been reported [31].…”

Section: Accepted M Manuscriptsupporting

confidence: 81%

See 1 more Smart Citation

The utility of scoring systems in critically ill cirrhotic patients admitted to a general intensive care unit

Emerson¹,

McPeake²,

O’Neill³

et al. 2014

Journal of Critical Care

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“…This compares favourably to the literature in which a weighted ICU mortality of 45% has been reported [31].…”

Section: Accepted M Manuscriptsupporting

confidence: 81%

“…The 31% mortality rate in this study is lower than reported in a review of the literature by Flood et al [31]. This reflects the trend towards improved outcomes of these patients over time [32], and compares to the 38% and 39% recently reported from two studies in British non-transplant ICUs [5,10].…”

Section: Accepted M Manuscriptcontrasting

confidence: 45%

The utility of scoring systems in critically ill cirrhotic patients admitted to a general intensive care unit

Emerson¹,

McPeake²,

O’Neill³

et al. 2014

Journal of Critical Care

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“…MELD likely outperformed Child-Pugh due to its inclusion of creatinine as a measured variable, and indeed acute kidney injury has been extensively shown in international literature to be a poor prognostic indication in hospitaladmitted cirrhotics [17] . The overall in-hospital mortality of 25% (21 of 85 patients) was significantly lower than in previous studies [18] , despite 55% being Child Pugh category C. This may have been a result of a high proportion being admitted for routine post-operative care rather than for unplanned organ dysfunction. Furthermore, selection bias may have applied wherein cirrhotics who were denied ICU admission on the basis of severe illness were not captured in our data, therefore not contributing to mortality rates.…”

Section: Discussioncontrasting

confidence: 54%

Cirrhotics Treated In Intensive Care Unit Have High Short Term Survival in the Absence of Extrahepatic Organ Dysfunction

Yeoh

Wills

Stoklosa

et al. 2016

Journal of Gastroenterology and Hepatology Research

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AIM: This retrospective study of 85 cirrhotics aimed to identify variables during the first 24 hours of intensive care unit (ICU) admission predicting mortality up to 30 days of hospital discharge, and to analyse the prognostic accuracy of common severity scores in predicting mortality. MATERIALS AND METHODS: Eighty-five patients with liver cirrhosis admitted to ICU at the Royal Hobart Hospital, a regional Australian center, from 2007 to 2013 inclusive were identified using International Classification of Disease coding and data extracted from medical records. Predictors of mortality were determined via logistic regression and the prognostic accuracy of 5 severity scores calculated by their area under the receiver-operating curve. These included 2 scores commonly used in liver disease; Child Pugh and Model for End-Stage Liver Disease (MELD); as well as 3 scores designed in the intensive care setting: Sequential Organ Failure Assessment (SOFA), Simplified Acute Physiology (SAPS II) and Acute Physiology and Chronic Health Evaluation (APACHE II). RESULTS: Significant variables predicting short-term mortality included infection (excluding spontaneous bacterial peritonitis), requirement for inotropes or mechanical ventilation, elevated creatinine, decreased Glasgow Coma Scale, decreased pH and elevated white cell count. However the presence of cirrhosis-specific complications such as hepatic encephalopathy, variceal bleeding and spontaneous bacterial peritonitis did not predict mortality and liver-specific prognostic severity scores (Child Pugh and MELD) performed more poorly than the other severity scores designed for the ICU setting. CONCLUSIONS: ICU admission for cirrhotics should not be deemed futile in the presence of hepatic dysfunction alone; cardiorespiratory, neurological and renal dysfunction should be taken into account. ICU-specific severity scores better prognosticate shortterm mortality compared to liver-specific scores.

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“…8 In 2012, Flood S et al performed a systemic review and found mortality of 40 to 50% among patients of alcoholic liver disease admitted in intensive care unit. 9 Mortality among patient of hepatobiliary disease admitted for surgical cause in intensive care unit was 27.82%. In 2005, Pitchumoni CS also reported a mortality rate of 25% among patient of complicated pancreatitis.…”

Section: Discussionmentioning

confidence: 99%

An audit of hepatobiliary diseases in a tertiary level intensive care unit in Nepal

Shrestha

Acharya

Shrestha

et al. 2017

J. Soc. Anesth. Nep.

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Background: Hepatobiliary diseases account for significant proportion of admission in our intensive care unit, a semi-closed, 11 bedded mixed medical-surgical unit. This study was conducted to study the profile of patients with various hepatobiliary diseases who required intensive care unit admissions with the aim of identifying the need for a hepatobiliary critical care facility. Methods: A retrospective study was designed and all consecutive patients admitted with hepatobiliary problems from January 2013 till December 2013 were enrolled in the study.Results: Out of 467 patients admitted, there were 61 (13.06%) patients with hepatobiliary diseases. Out of 61 patients, there were 24 (39.3%) patients with medical cause for hepatobiliary disease and 37 (60.7%) patients with a surgical cause. The majority of the patients 52.45% were male. The overall mortality in these patients was 37.70%. The mortality in patients with surgical cause for the hepatobiliary disease was less (27.02%). Encephalopathy was a common condition leading to ICU admission. The common medical conditions were Cirrhosis secondary to Alcoholic Liver disease and Acute Fulminant Hepatic Failure. The commonest surgical conditions were Severe Pancreatitis, Post-Whipple's surgery, postoperative sepsis after Cholecystectomy, Liver Injury secondary to Road Traffic Accidents and Severe Cholangitis. Conclusion: The number of patients presenting to our multidisciplinary unit with hepatobiliary diseases is high and this group of patients have a high mortality. Though the numbers do not suggest an immediate need for a Hepatobiliary intensive care unit, the increasing trend suggests such a facility would be the need of time in near future.

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Mortality of Patients with Alcoholic Liver Disease Admitted to Critical Care: A Systematic Review

Cited by 5 publications

References 23 publications

The utility of scoring systems in critically ill cirrhotic patients admitted to a general intensive care unit

The utility of scoring systems in critically ill cirrhotic patients admitted to a general intensive care unit

Cirrhotics Treated In Intensive Care Unit Have High Short Term Survival in the Absence of Extrahepatic Organ Dysfunction

An audit of hepatobiliary diseases in a tertiary level intensive care unit in Nepal

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