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General liver II
PWE-275 Multiple organ dysfunction syndrome (MODS), rather than the need for renal replacement therapy per se, dictates poor prognosis in patients with cirrhosis admitted to ICU
  1. R D Abeles,
  2. D L Shawcross,
  3. M J McPhail,
  4. A Yeoman,
  5. N Taylor,
  6. A Portal,
  7. M J Austin,
  8. G Auzinger,
  9. C Willars,
  10. W Bernal,
  11. J A Wendon
  1. Institute of Liver Studies, King's College London at King's College Hospital,

Abstract

Introduction Critically ill cirrhotics admitted to ICU who receive renal replacement therapy (RRT) have a poor prognosis. It is unclear whether prognosis relates to renal dysfunction per se or whether RRT is one facet of MODS. We report the 7-year experience of outcomes and physiological disturbances in cirrhotics admitted to ICU who received RRT.

Methods We analysed physiological and biochemical variables on admission for 478 cirrhotic patients admitted to ICU, excluding those transplanted during that hospital admission. Patients were cohorted on RRT requirement (RRT+/RRT) at any point during ICU admission. Outcome, organ failure scores and utilisation of organ support were recorded.

Results Of 253 RRT+ patients, 22% survived ICU and 13% survived hospital. Of 225 RRT, 81% survived ICU and 59% survived hospital (p. On day 1 of admission, RRT+ had a higher prevalence of systemic inflammatory response syndrome (76% vs 62%), Child-Pugh (12 vs 11), MELD (32 vs 17) and SOFA scores (13 vs 11) (pEven when the renal component was removed from the SOFA score (SOFAminusRENAL), RRT+ had higher scores than RRT- (9 vs 7) (p. 23% of RRT+ commenced RRT after day 3 of admission; this did not affect ICU or hospital survival compared to those that commenced RRT before day 3. RRT+ survivors required less ventilation (39% vs 93%) and vasopressors (52% vs 89%) than RRT+ non-survivors and had lower Child-Pugh (12 vs 13), SOFA (12 vs 14) and SOFAminusRENAL (8 vs 10) scores (p=1 of admission. 23 patients required RRT but no other organ support, 18/23 (78%) survived to ICU discharge and 11/23 (48%) to hospital discharge.

Conclusion The extent of MODS, rather than requirement of RRT per se, dictates poor prognosis in cirrhotics needing RRT in ICU. Requirement for RRT should not preclude admission to ICU, rather, prognostication should take into account other elements of MODS; in particular a concomitant requirement for circulatory and respiratory support.

Competing interests None declared.

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