Prevalence and outcome of cirrhosis patients admitted to UK intensive care: a comparison against dialysis-dependent chronic renal failure patients
Prevalence and outcome of cirrhosis patients admitted to UK intensive care: a comparison against dialysis-dependent chronic renal failure patients
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DOI：
10.1007/s00134-012-2523-2
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发表时间：
2012-06-01
影响因子：
38.9
通讯作者：
Harrison, David A.
中科院分区：
文献类型：
--
作者：
O'Brien, Alastair J.;Welch, Cathy A.;Harrison, David A.
在英国，入住重症监护病房 (ICU) 的失代偿性肝硬化患者被认为预后特别差。我们对 1995 年至 2008 年入住普通重症监护病房的肝硬化患者与既往患有慢性肾功能衰竭的患者进行了描述性分析。数据来自重症监护国家审计和研究中心病例混合计划数据库，该数据库包含英格兰、威尔士和北爱尔兰的 192 个成人重症监护病房。肝硬化占入院总人数的 2.6%（16,096 名患者），平均年龄 52.5 岁，男性占多数（接近 60%）。医院死亡率很高（> 55 %），尽管近年来死亡率提高了 5 %，而且中位住院时间很短（2.5 天）。需要器官支持的严重脓毒症肝硬化患者的死亡率为 65-90%，而无需器官支持的患者死亡率为 33-39%。相反，慢性肾功能衰竭患者的死亡率较低（42%），尽管其特征相似且急性生理学和慢性健康评估（APACHE）II评分较高。 APACHE II 评分低估了肝硬化患者的死亡率。尽管肝硬化患者具有相似的特征，但与既往肾衰竭患者相比，其结果却较差。器官衰竭时，尤其是败血症时，生存率会大大恶化。尽管近年来有所增加，但入院人数较少，而且一般来说，入住 ICU 的时间较短。单器官衰竭患者的生存率可接受，死亡率有所改善；尽管我们没有关于那些拒绝入住 ICU 可能导致生存偏差的数据。鉴于多器官衰竭患者的死亡率极高，应限制/撤回对此类患者的支持。
Patients with decompensated liver cirrhosis who are admitted to intensive care units (ICU) are perceived, within the UK, as having a particularly poor prognosis.We performed a descriptive analysis of cirrhosis patients admitted to general critical care units 1995-2008 compared to patients admitted with pre-existing chronic renal failure. Data were obtained from the Intensive Care National Audit and Research Centre Case Mix Programme Database incorporating 192 adult critical care units in England, Wales and Northern Ireland.Cirrhosis accounted for 2.6 % (16,096 patients) of total admissions with mean age 52.5 years and male preponderance (similar to 60 %). Hospital mortality was high (> 55 %) although this improved 5 % in recent years, and median length of stay was short (2.5 days). Mortality in cirrhotics with severe sepsis requiring organ support was 65-90 %, compared to 33-39 % in those without. Conversely, patients with chronic renal failure had lower mortality (42 %) despite similar characteristics and higher acute physiology and chronic health evaluation (APACHE) II scores. The APACHE II score under-predicted mortality in cirrhotics.Cirrhosis patients exhibit worse outcomes compared to pre-existing renal failure patients, despite similar characteristics. Survival worsens considerably with organ failure, especially with sepsis. They represent a small number of admissions, albeit increasing over recent years, and, in general, have a short ICU stay. Patients with single organ failure have acceptable survival rates and mortality has improved; although we have no data on those refused ICU admission potentially causing survival bias. Given the extremely high mortality in patients with multi-organ failure, support should be limited/withdrawn in such patients.