Philippe Meersseman1, Lies Langouche2, Johannie du Plessis3, Hannelie Korf3, Michaël Mekeirele4, Wim Laleman5, Frederik Nevens5, Alexander Wilmer4, Greet Van den Berghe2, Schalk W van der Merwe6. 1. Department of Internal Medicine, University Hospitals Leuven [KU Leuven], Belgium. Electronic address: philippe.meersseman@uzleuven.be. 2. Clinical Division and Laboratory of Intensive Care Medicine, Department of Cellular and Molecular Medicine, University of Leuven [KU Leuven], Belgium. 3. Laboratory of Hepatology, University of Leuven [KU Leuven], Belgium. 4. Department of Internal Medicine, University Hospitals Leuven [KU Leuven], Belgium. 5. Laboratory of Hepatology, University of Leuven [KU Leuven], Belgium; Department of Gastroenterology and Hepatology, University Hospitals Leuven [KU Leuven], Belgium. 6. Laboratory of Hepatology, University of Leuven [KU Leuven], Belgium; Department of Gastroenterology and Hepatology, University Hospitals Leuven [KU Leuven], Belgium. Electronic address: schalk.vandermerwe@uzleuven.be.
Abstract
BACKGROUND & AIMS: Acute-on-chronic liver failure (ACLF) is characterized by acute decompensation of cirrhosis, development of organ failure and high short-term mortality. Whether the outcome in patients admitted to the intensive care unit (ICU) with ACLF differs from other ICU populations is unknown. We compared the clinical course and host response in ICU patients with or without ACLF, matched for baseline severity of illness scores and characteristics. METHODS: From the large prospective EPaNIC randomized control trial database (n = 4,640), 133 patients were identified with cirrhosis of whom 71 fulfilled the Chronic Liver Failure Consortium criteria for ACLF. These patients were matched for type and severity of illness and demographics to 71 septic and 71 medical ICU patients from the same database without chronic liver disease. Clinical, biochemical and outcome parameters were compared in this cohort study of 213 patients. In a subset of 100 patients, day 1 serum cytokines were quantified. RESULTS: The outcome of ACLF, when compared to septic or medical ICU patients, matched for baseline parameters of illness severity, was similar regarding length of ICU stay, development of new infections, organ failure and septic shock. ICU, hospital and 90-day mortality were similar between the groups. C-reactive protein and platelet levels were lower in patients with ACLF throughout the first week. Cytokines, including IL-10, IL-1β, IL-6, and IL-8, were similarly elevated in ACLF and septic ICU patients on day 1. However, TNF-α levels were higher in patients with ACLF. CONCLUSION: Patients with ACLF admitted to the ICU showed comparable clinical and ICU outcomes as ICU patients without chronic liver disease, but with similar baseline severity of illness characteristics. This suggests that ICU admission criteria should not be different in ACLF populations. LAY SUMMARY: Liver function may abruptly deteriorate in patients with chronic liver disease with cirrhosis, often resulting in these patients being admitted to an intensive care unit (ICU) with organ failure. Previous studies have indicated that this sudden deterioration, called acute-on-chronic liver failure is associated with very high mortality rates, which often resulted in deferred ICU care because of a perception of futility. Our study now shows that the ICU course and outcome are not different when patients with acute-on-chronic liver failure are compared to other ICU patients matched for severity of illness. This demonstrates that patients with acute-on-chronic liver failure deserve the same ICU care given to other ICU populations.
BACKGROUND & AIMS: Acute-on-chronic liver failure (ACLF) is characterized by acute decompensation of cirrhosis, development of organ failure and high short-term mortality. Whether the outcome in patients admitted to the intensive care unit (ICU) with ACLF differs from other ICU populations is unknown. We compared the clinical course and host response in ICU patients with or without ACLF, matched for baseline severity of illness scores and characteristics. METHODS: From the large prospective EPaNIC randomized control trial database (n = 4,640), 133 patients were identified with cirrhosis of whom 71 fulfilled the Chronic Liver Failure Consortium criteria for ACLF. These patients were matched for type and severity of illness and demographics to 71 septic and 71 medical ICU patients from the same database without chronic liver disease. Clinical, biochemical and outcome parameters were compared in this cohort study of 213 patients. In a subset of 100 patients, day 1 serum cytokines were quantified. RESULTS: The outcome of ACLF, when compared to septic or medical ICU patients, matched for baseline parameters of illness severity, was similar regarding length of ICU stay, development of new infections, organ failure and septic shock. ICU, hospital and 90-day mortality were similar between the groups. C-reactive protein and platelet levels were lower in patients with ACLF throughout the first week. Cytokines, including IL-10, IL-1β, IL-6, and IL-8, were similarly elevated in ACLF and septic ICUpatients on day 1. However, TNF-α levels were higher in patients with ACLF. CONCLUSION:Patients with ACLF admitted to the ICU showed comparable clinical and ICU outcomes as ICU patients without chronic liver disease, but with similar baseline severity of illness characteristics. This suggests that ICU admission criteria should not be different in ACLF populations. LAY SUMMARY: Liver function may abruptly deteriorate in patients with chronic liver disease with cirrhosis, often resulting in these patients being admitted to an intensive care unit (ICU) with organ failure. Previous studies have indicated that this sudden deterioration, called acute-on-chronic liver failure is associated with very high mortality rates, which often resulted in deferred ICU care because of a perception of futility. Our study now shows that the ICU course and outcome are not different when patients with acute-on-chronic liver failure are compared to other ICU patients matched for severity of illness. This demonstrates that patients with acute-on-chronic liver failure deserve the same ICU care given to other ICU populations.
Authors: Fabian Benz; Andreas Bogen; Michael Praktiknjo; Christian Jansen; Carsten Meyer; Alexander Wree; Muenevver Demir; Sven Loosen; Mihael Vucur; Robert Schierwagen; Frank Tacke; Jonel Trebicka; Christoph Roderburg Journal: PLoS One Date: 2020-04-17 Impact factor: 3.240
Authors: Naeem Goussous; Wen Xie; Talan Zhang; Saad Malik; Josue Alvarez-Casas; Stephen H Gray; Rolf N Barth; Paul J Thuluvath; John C LaMattina Journal: Transplant Direct Date: 2021-11-17
Authors: Stefan Chiriac; Carol Stanciu; Ana Maria Singeap; Catalin Victor Sfarti; Tudor Cuciureanu; Anca Trifan Journal: Turk J Gastroenterol Date: 2020-12 Impact factor: 1.852
Authors: Grzegorz Niewiński; Szymon Morawiec; Maciej K Janik; Michał Grąt; Agata Graczyńska; Krzysztof Zieniewicz; Joanna Raszeja-Wyszomirska Journal: Med Sci Monit Date: 2020-05-16