Introduction Hospital admissions with decompensated chronic alcoholic liver disease (ALD) have been increasing, leading to increased pressure on intensive care unit (ICU) services. We aimed to determine the outcome and prognostic factors for patients with ALD requiring admission to ICU.
Methods This was a retrospective study over a five year period (January 2006 – December 2010) of ICU admissions with ALD to St James’ Hospital Leeds, either known or at first presentation. We reviewed in detail case notes and the laboratory database based on a pre-established proforma. ICU and hospital mortality were recorded along with outcome in diagnostic and organ support subgroups.
Results 29 patients with ALD admitted to ICU were included, median age 46 yrs, 79% males. 82.7% (24/29) were Child Pugh Score C. Mean ITU stay was 5.2 days. Overall ICU and hospital mortality was 51.7% (15/29) and 65.5% (19/29) respectively. 20 (69%) were previously known ALD and 9 (31%) were at first presentation. ICU and in hospital mortality in first presentation ALD group was 67% (6/9) and 89% (8/9) compared with 45% (9/20) and 55% (11/20) respectively for previously known ALD. The reasons for admission to ICU were variceal bleeding (59%), sepsis (17%) and 37% other (encephalopathy, other causes of bleeding, seizures, renal support). ICU and in hospital mortality in the variceal bleeding subgroup was 47% and 58% respectively compared to 100% ICU and hospital mortality for sepsis. Patients with multiorgan failure had the worst prognosis. Organ failure was predefined based on level of support required on admission to ITU.
Conclusion Mortality remains high in ALD patients admitted to ICU. In this study, acute variceal bleeding and single or dual organ support were associated with better survival outcomes compared with other presentations and outcomes were not better in patients presenting for the first time with ALD compared to recurrent admissions. Escalation therapy to ICU for patients with sepsis or requiring multiple organ support may be futile.
Disclosure of Interest None Declared
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S. J. Thomson, C. Moran, M. L. Cowan, S. Musa, R. Beale, D. Treacher, M. Hamilton, R. M. Grounds, T. M. Rahman Outcomes of Critically Ill Patients with Cirrhosis Admitted to Intensive Care: An Important Perspective from the Non-transplant
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