Morbidity and mortality in icu patients with end stage liver disease

Acute or chronic liver failure is associated with numerous complications which may occur in combination and patients may require intensive care unit [ICU] treatment; many do not survive. Therefore, it seems necessary to identify prognostic clinical parameters and risk factors at the time of ICU admission. To estimate the frequency of different morbidity changes and to evaluate risk factors responsible for mortality among patients with end stage liver disease [ESLD] admitted to the ICU. A total of 120 patients with ESLD were enrolled [102 males [85%] and 18 females [15%]. All were consecutively admitted to the ICU at the Tropical Medicine and Gastroenterology Department, Assiut University Hospital from May 1[st] to August 31[st], 2013. Full history taking, thorough clinical examination, full investigations and assessment of patients accordinglo C-hild-Turcotte-Pugh [CTP] class and Model for End-stage Liver Disease [MELD] score were done with close monitoring and follow up. The mean age of patients was [56.23 +/- 11.21] years. Regarding clinical presentation, hepatic cncephalopathy [HE] was found in 87.5%, jaundice in 60%, hematemesis in 41.7%. hepatorenal syndrome [MRS] in 35.8% and spontaneous bacterial peritonitis [SBP] in 20.8%. The majority of patients [86.7%] were CTP class C. Mortality rate was 57.5%; the main causes of death were HRS [10.8%], HE[21.7], aspiration pneumonia [10%], septic shock [2.5%] and irreversible shock in only.7%. There was a significant correlation between mortality and old age, CTP and MELD scores and a longer stay at the ICU. We found six risk factors independently affecting the outcome of ESLD patients in the ICU. Those were HE, jaundice, HRS, increased white blood cell count, increased hemoglobin and decreased prothrombin concentrations. Among ESLD patients having more risk factors, mortality rates were higher, 86.2% with 5-6 risk factors and 21.7% with 1-2 risk factors. Rates of improvement were highest with 1-2 risk factors [78.3%] and worst with 5-6 risk factors [13.8%]. The mortality rate in of ESLD patients admitted to the ICU was 57.5% and the most common cause of death was HRS. CTP and MELD scores as well as HE, HRS and jaundice were significant predictors of mortality in ESLD patients in the ICU. Mortality increased with increased number of risk factors. Creatinine level, white blood cell count, hemoglobin and prothrombin concentrations were indepejident risk factors affecting the outcome of ESLD patients in the ICU

Risk factors and outcome in ICU patients with end-stage liver disease

Acute or chronic liver failure is associated with numerous complications that may occur in combination, and patients may require ICU treatment. Therefore, it seems necessary to identify prognostic clinical parameters and risk factors at the time of ICU admission. The present study aims to estimate the frequency of mortality and evaluate morbidity from cirrhosis in patients with end-stage liver disease [ESLD] admitted to the ICU and evaluate the relationship between the demographic, clinical, and laboratory data [potential risk factors] of those patients and mortality. A total of 120 patients with ESLD were enrolled [102 [85%] male and 18 [15%] female patients]. History taking, clinical examination, and other laboratory investigations were carried out, and patients were classifi ed according to the Child-Turcotte-Pugh [CTP] and the model for endstage liver disease [MELD] scores. Regarding the clinical presentation, hepatic encephalopathy [HE] was found in 87.5% of patients, jaundice in 60%, hematemesis in 41.7%, hepatorenal syndrome [HRS] in 35.8%, and spontaneous bacterial peritonitis in 20.8% of patients. The mortality rate was 57.5%; the main causes of death were HRS [40.8%], HE [21.7%], aspiration pneumonia [10%], septic shock [2.5%], and irreversible shock [1.7%]. There was a significant relationship between mortality and old age, CTP and MELD scores, and a longer stay at the ICU. Increased white blood cell count, increased hemoglobin and decreased prothrombin concentration, and elevated creatinine were independent risk factors of mortality in ESLD patients in the ICU. Mortality rates were higher in patients with 5-6 risk factors [86.2%] than in those with 1-2 risk factors [21.7%]. Mortality rate in ESLD patients admitted to the ICU was 57.5% and the most common cause of death was HRS. CTP, MELD score, HE, HRS, and jaundice were significant predictors of mortality in ESLD patients. Mortality increased with increased number of risk factors. Creatinine level, white blood cell count, hemoglobin, and prothrombin concentration were independent risk factors of mortality in ESLD patients