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P30 Lung injury and its prognostic significance in acute liver failure
  1. V K Audimoolam1,
  2. M McPhail1,2,
  3. S Desai1,
  4. C Willars1,
  5. W Bernal1,
  6. J A Wendon1,
  7. G Auzinger1
  1. 1King's College Hospital
  2. 2Imperial College London

Abstract

Introduction Acute liver failure (ALF) is a multi system illness. Data on the incidence and outcome of acute lung injury (ALI) and acute respiratory distress syndrome (ARDS) complicating ALF is scant1. We analysed radiological, gas exchange and ventilator data of consecutive patients admitted with ALF/subacute liver failure (SALF) to a tertiary liver intensive therapy unit (LITU).

Aim The main objective of this assessment was to identify the incidence of ALI/ARDS in ALF/SALF and the impact it has on outcome.

Method All patients with ALF/SALF receiving mechanical ventilation who were admitted between January 2007 and February 2011 were included. Patients were categorised according to the ARDS network consensus definition as: No lung injury present (NALI), ALI (P/F <300 mm Hg) and ARDS (P/F <200 mm Hg). Chest radiographs were independently assessed by two observers for the presence of bilateral infiltrates. Absence of left atrial pressure elevation was based on haemodynamic and echocardiographic assessment.

Results 146 (M: F 71:75) patients with ALF/SALF were studied. 31 patients (21%) fulfilled ARDS network criteria, 14 ARDS (9.6%), 17 ALI (11.6%), within the first 72 h following LITU admission. ARDS patients required higher levels of positive end expiratory pressure (10 vs 6 ALI and 7cmH2O NALI, p=0.016) and had a worse oxygenation index (10.7 vs 4.3 ALI, 4.5 NALI, p≤0.001). There was a trend towards reduced compliance of the respiratory system in ARDS and ALI patients (p=0.07 vs NALI) and an increased number of ventilator days (NALI 10d, ALI 12d, ARDS 17d). Duration of LITU stay (p=0.175) and survival (p=0.877) were not affected by the presence of ALI/ARDS. Type of liver disease presentation ALF/SALF, poor prognostic markers of liver failure, that is, lactate, INR, bilirubin, presence of encephalopathy and intracranial hypertension did not correlate with lung injury presentation. Also no association with inotrope requirements (p=0.495), need for extracorporeal renal support (p=0.565) and severity of organ failure scores was found.

Conclusion The incidence of lung injury is relatively low in ALF of mixed aetiology. Less than 10% of patients fulfilled ARDS criteria. Overall presence of ALI/ARDS appeared to have a limited impact on outcome.

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