ABSTRACT
OBJECTIVE: Endoscopic retrograde cholangio-pancreatography (ERCP) is useful for the management of biliary tract diseases; in patients with cirrhosis, portal hypertension may increase the risk for complications from ERCP. We evaluated the outcome and risk factors related to ERCP in patients with cirrhosis and portal hypertension. PATIENTS AND METHODS: In this case-control study, 37 patients (71 procedures) with cirrhosis and portal hypertension (group 1) and 37 controls (group 2) undergoing ERCP were included. Logistic regression and receiver operating characteristic curve analysis were used to predict the risk factors. RESULTS: Mean Child-Pugh and model for end-stage liver disease (MELD) score were 9±2.1 and 17.8±6, respectively. Ascites was present in 46% of the patients, esophageal varices in 63% (large esophageal varices 43.7%), and hepatic encephalopathy in 16%. The main indication for ERCP in both groups was choledocholithiasis. Successful cannulation rate was 97% in both groups. Biliary sphincterotomy was performed more frequently in group 2 than in group 1 (60 vs. 35%, P=0.036); there was no difference in the frequency of complications related to ERCP between cirrhotics and noncirrhotics (10 vs. 8%, P=0.677). Complications in patients with cirrhosis were related to lower alkaline phosphatase and sphincterotomy rate; in the multivariable analysis only sphincterotomy was independently associated with complications [odds ratio 9.8 (1.7-56.3)]. Receiver operating characteristic curve analysis yielded a MELD score of more than 16 to best predict complications after ERCP in cirrhosis. CONCLUSION: Outcomes after ERCP in patients with cirrhosis are similar to those of noncirrhotics despite the alteration in coagulation parameters and the presence of disease-specific complications; however, a more cautious approach in patients with cirrhosis undergoing sphincterotomy and MELD of more than 16 is needed.
Subject(s)
Cholangiopancreatography, Endoscopic Retrograde , Choledocholithiasis/surgery , Hypertension, Portal/epidemiology , Liver Cirrhosis/epidemiology , Postoperative Complications/epidemiology , Sphincterotomy, Endoscopic/statistics & numerical data , Adult , Aged , Ascites/epidemiology , Ascites/etiology , Case-Control Studies , Choledocholithiasis/epidemiology , Comorbidity , End Stage Liver Disease , Esophageal and Gastric Varices/epidemiology , Esophageal and Gastric Varices/etiology , Female , Hepatic Encephalopathy/epidemiology , Hepatic Encephalopathy/etiology , Humans , Hypertension, Portal/etiology , Liver Cirrhosis/complications , Logistic Models , Male , Middle Aged , Multivariate Analysis , Odds Ratio , ROC Curve , Retrospective Studies , Risk Factors , Severity of Illness IndexABSTRACT
PURPOSE: We aimed to investigate the effect of baseline demographic, clinical, and functional characteristics of intensive care unit (ICU) patients with multiple-organ failure (MOF) on their functional recovery at 6 and 12 months posthospitalization. MATERIALS AND METHODS: A total of 545 consecutively admitted adult patients with MOF during on admission were included in the study. Patients' functional status was prospectively assessed and compared with the baseline status and at 6 and 12 months postdischarge, using the Modified Rankin Scale and the Glasgow Outcome Scale Extended. Severity of disease on admission was assessed using the Acute Physiology and Chronic Health Evaluation II and the Simplified Acute Physiology Score II. RESULTS: A total of 266 patients were followed up. Functional status among MOF survivors improved between the 6th and 12th month postdischarge from the ICU. Higher functional status before admission, lower severity scores on admission, and younger age positively affected the improvement in functional status after ICU discharge. CONCLUSIONS: The level of functional status befre ICU admission should be considered not only in research studies looking a long-term outcomes from ICU but also in the clinical care planning of critically ill patients during and after their ICU admission.