Septic shock in patients with cirrhosis

Moreau, Richard; Hadengue, Antoine; Soupison, Thierry; Kirstetter, P; Mamzer, Marie‐France; Vanjak, Denis; Vauquelin, Philippe; Assous, Michel; Sicot, C

doi:10.1097/00003246-199206000-00008

Cited by 122 publications

(14 citation statements)

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“…Nevertheless, the occurrence of life-threatening conditions in cirrhosis patients is frequent and would explain higher mortality rates in the HIV/HCV group. [46]. Then, CHC and cirrhosis should be considered targets for improving the survival of HIV-infected patients in the ICU in the future.…”

Section: Discussionmentioning

confidence: 99%

Mortality of patients infected with HIV in the intensive care unit (2005 through 2010): significant role of chronic hepatitis C and severe sepsis

et al. 2014

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IntroductionThe combination antiretroviral therapy (cART) has led to decreased opportunistic infections and hospital admissions in human immunodeficiency virus (HIV)-infected patients, but the intensive care unit (ICU) admission rate remains constant (or even increased in some instances) during the cART era. Hepatitis C virus (HCV) infection is associated with an increased risk for hospital admission and/or mortality (particularly those related to severe liver disease) compared with the general population. The aim of this study was to assess the mortality among HIV-infected patients in ICU, and to evaluate the impact of HIV/HCV coinfection and severe sepsis on ICU mortality.MethodsWe carried out a retrospective study based on patients admitted to ICU who were recorded in the Minimum Basic Data Set (2005 through 2010) in Spain. HIV-infected patients (All-HIV-group (n = 1,891)) were divided into two groups: HIV-monoinfected patients (HIV group (n = 1,191)) and HIV/HCV-coinfected patients (HIV/HCV group (n = 700)). A control group (HIV(-)/HCV(-)) was also included (n = 7,496).ResultsAll-HIV group had higher frequencies of severe sepsis (57.7% versus 39.4%; P < 0.001) than did the control group. Overall, ICU mortality in patients with severe sepsis was much more frequent than that in patients without severe sepsis (other causes) at days 30 and 90 in HIV-infected patients and the control group (P < 0.001). Moreover, the all-HIV group in the presence or absence of severe sepsis had a higher percentage of death than did the control group at days 7 (P < 0.001), 30 (P < 0.001) and 90 (P < 0.001). Besides, the HIV/HCV group had a higher percentage of death, both in patients with severe sepsis and in patients without severe sepsis compared with the HIV group at days 7 (P < 0.001) and 30 (P < 0.001), whereas no differences were found at day 90. In a bayesian competing-risk model, the HIV/HCV group had a higher mortality risk (adjusted hazard ratio (aHR) = 1.44 (95% CI = 1.30 to 1.59) and aHR = 1.57 (95% CI = 1.38 to 1.78) for patients with and without severe sepsis, respectively).ConclusionsHIV infection was related to a higher frequency of severe sepsis and death among patients admitted to the ICU. Besides, HIV/HCV coinfection contributed to an increased risk of death in both the presence and the absence of severe sepsis.Electronic supplementary materialThe online version of this article (doi:10.1186/s13054-014-0475-3) contains supplementary material, which is available to authorized users.

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Section: Discussionmentioning

confidence: 99%

Mortality of patients infected with HIV in the intensive care unit (2005 through 2010): significant role of chronic hepatitis C and severe sepsis

et al. 2014

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“…Several studies have highlighted the major influence of cirrhosis on the susceptibility to severe bacterial infections [3,4]. Indeed, the overall mortality rate of septic shock remains particularly high in cirrhotic patients, ranging from 60% to 100% [5-7], raising the question of indications of aggressive and extensive organ failure support in such patients.…”

Section: Introductionmentioning

confidence: 99%

Increased survival of cirrhotic patients with septic shock

et al. 2013

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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.

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“…To our knowledge, none of them used echocardiography and most were performed in the 1980s or the early 1990s. Overall, the results show significantly higher CI values (as measured by thermodilution) and far higher mortality in patients with cirrhosis compared with those without cirrhosis (10–12). In one study, for instance, mortality in the intensive care unit (ICU) was 100% in patients with cirrhosis compared with 43% in patients without cirrhosis (10).…”

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confidence: 81%

“…Few studies have investigated the hemodynamics of patients with cirrhosis and septic shock (10–12). To our knowledge, none of them used echocardiography and most were performed in the 1980s or the early 1990s.…”

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confidence: 99%