Pre-existing cirrhosis is associated with increased mortality of traumatic patients: Analysis of cases from a trauma center in East China

Abstract

AIM:To determine the impact of cirrhosis on trauma patients and define the factors predicting death. METHODS:The data on patients admitted to the trauma center from January 2000-2005 were studied retrospectively. The clinical variables were recorded and compared to identify the factors differentiating cirrhotic trauma survivors from non survivors. Child's classification criteria were derived from the reviewed charts of cirrhotic trauma patients to evaluate their predictive value in cirrhotic trauma. Trauma registry was also used to generate a trauma control group by matching for age, sex, abbreviated injury score (AIS) over the same period of time. The outcome variables compared were mortality rate, time of ICU and hospital stay. Results were expressed as mean ± SD. These data were analyzed by SPSS.11.0 statistical software. Univariate analysis was performed to identify significant medical factors for survivor and non survivors subjected to chi-square test.Fisher's exact test and Student's t test were performed to determine the statistical difference between cirrhotic and control groups. P < 0.05 was considered statistically significant. RESULTS:Poor prognosis of traum patients was associated with one or more of the following findings: ascitcs, hyperbilirubinemia (more than 2 mg/dL), hypoalbuminemia (less than 3.5 mg/dL), and prolonged prothrombin time (more than 12.5 seconds). Although Child's classification was used to predict the outcome in cirrhotic patients undergoing portacaval shunt procedures, no significant difference was found in mortality rate as a function of Child's classification. CONCLUSION:Cirrhosis is associated with a higher mortality, a longer time of ICU and hospital stay of trauma patients. It seems that treatment of trauma patients with pre-existing severe liver disease is a challenge to surgeons.

Liver Cirrhosis and Traumatic Brain Injury: A Fatal Combination Based on National Trauma Databank Analysis

“…Although the increased risk for adverse outcomes in cirrhotic patients after injury has been well documented, [6][7][8][9][10][11][12][13][14][15] the effect of liver failure on outcomes in patients with TBI, however, has not yet been examined. The present study, based on a cohort of isolated head injured trauma patients, found a significantly increased overall mortality rate at 34 per cent among cirrhotic TBI patients compared with a rate of 18.1 per cent in their noncirrhotic counterparts.…”

“…L IVER CIRRHOSIS has been identified as a significant risk factor for both morbidity and mortality in elective [1][2][3][4][5] and in emergently ill surgical patients. [6][7][8][9][10][11][12][13][14][15] In a previous investigation from our institution, cirrhotic trauma patients undergoing laparotomy had an almost three-fold increased risk of developing severe complications and a seven-fold increased risk of death compared with a matched cohort of noncirrhotic trauma victims requiring emergent abdominal surgery. 6 In patients with traumatic brain injury (TBI), however, no studies exist documenting the impact of liver cirrhosis on their in-hospital outcomes.…”