The impact of organ dysfunction in cirrhosis: Survival at a cost?
The impact of organ dysfunction in cirrhosis: Survival at a cost?
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DOI：
10.1016/j.jhep.2011.12.014
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发表时间：
2012-01-01
影响因子：
25.7
通讯作者：
Wendon, Julia A.
中科院分区：
文献类型：
--
作者：
Shawcross, Debbie L.;Austin, Mark J.;Wendon, Julia A.
背景和目标：肝硬化的发病率和随后发生的需要重症监护室（ICU）支持的器官功能障碍（OD）正在上升。从历史上看，危重病人被认为具有预后不良和大量costs.Methods成本：其目的是前瞻性地分析资源利用率和成本的一个大的队列的患者（n = 660）从2000年至2007年肝硬化和OD入住肝ICU。收集Child Pugh、MELD、SOFA、APACHE II和器官支持要求。每天计算治疗干预评分系统（TISS）评分，这是一种用于估计ICU费用的有效工具。Logistic回归被用来确定独立的预测因素增加cost.Results：酒精是最常见的病因（47%）和静脉曲张出血（VB）的最常见的原因入院（35%）。74%的病例需要有创辅助治疗，49%需要血管加压药，50%需要肾脏替代治疗。49%的非移植患者存活到ICU出院。每例患者的中位TISS评分和ICU费用分别为261和E14，139。VB患者的生存率最高（53% vs. 24%; p
Background & Aims: The incidence of cirrhosis and subsequent development of organ dysfunction (OD) requiring intensive care unit (ICU) support is rising. Historically, critically ill cirrhotics are perceived as having poor prognosis and substantial cost of care.Methods: The aim was to prospectively analyse resource utilisation and cost of a large cohort of patients (n = 660) admitted to a Liver ICU from 2000 to 2007 with cirrhosis and OD. Child Pugh, MELD, SOFA, APACHE II, and organ support requirements were collected. The Therapeutic Intervention Scoring System (TISS) score, a validated tool for estimating cost in ICU, was calculated daily. Logistic regression was used to determine independent predictors of increased cost.Results: Alcohol was the most common etiology (47%) and variceal bleeding (VB) the most common reason for admission (35%). Invasive ventilatory support was required in 74% of cases, vasopressors in 49%, and 50% required renal replacement therapy. Forty-nine per cent of non-transplanted patients survived to ICU discharge. Median TISS score and ICU cost per patient were 261 and E14,139, respectively. VB patients had the highest survival rates (53% vs. 24%; p