Yu-Feng Huang1,2, Chao-Shun Lin3,4,5, Yih-Giun Cherng2,3, Chun-Chieh Yeh6,7, Ray-Jade Chen8,9, Ta-Liang Chen3,10, Chien-Chang Liao11,12,13,14,15. 1. Department of Anesthesiology, Taitung MacKay Memorial Hospital, Taitung, Taiwan. 2. Department of Anesthesiology, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan. 3. Department of Anesthesiology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan. 4. Department of Anesthesiology, Taipei Medical University Hospital, Taipei, Taiwan. 5. Anesthesiology and Health Policy Research Center, Taipei Medical University Hospital, Taipei, Taiwan. 6. Department of Surgery, China Medical University Hospital, Taichung, Taiwan. 7. Department of Surgery, University of Illinois, Chicago, USA. 8. Department of Surgery, Taipei Medical University Hospital, Taipei, Taiwan. 9. Department of Surgery, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan. 10. Department of Anesthesiology, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan. 11. Department of Anesthesiology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan. jacky48863027@yahoo.com.tw. 12. Department of Anesthesiology, Taipei Medical University Hospital, Taipei, Taiwan. jacky48863027@yahoo.com.tw. 13. Anesthesiology and Health Policy Research Center, Taipei Medical University Hospital, Taipei, Taiwan. jacky48863027@yahoo.com.tw. 14. Research Center of Big Data and Meta-Analysis, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan. jacky48863027@yahoo.com.tw. 15. School of Chinese Medicine, College of Chinese Medicine, China Medical University, Taichung, Taiwan. jacky48863027@yahoo.com.tw.
Abstract
BACKGROUND: The impact of liver cirrhosis on the outcomes of admission to intensive care unit (ICU) is not completely understood. Our purpose is to identify risk factors for mortality in ICU patients with liver cirrhosis. METHODS: Using reimbursement claims from Taiwan's National Health Insurance Research Database from in 2006-2012, 1,250,300 patients were identified as having ICU stays of more than 1 day, and 37,197 of these had liver cirrhosis. With propensity score-matching for socioeconomic status, pre-existing medical conditions, and cirrhosis-related morbidities, 37,197 ICU patients without liver cirrhosis were selected for comparison. Adjusted odds ratios (ORs) and 95% confidence intervals (CIs) of cirrhosis associated with 30-day, ICU, and one-year mortality were calculated. RESULTS: Compared with control, cirrhotic patients had higher 30-day mortality (aOR 1.60, 95% CI 1.53 to 1.68), particularly those with jaundice (aOR 2.23, 95% CI 2.03 to 2.45), ascites (aOR 2.32, 95% CI 2.19 to 2.46) or hepatic coma (aOR 2.21, 95% CI 2.07 to 2.36). Among ICU patients, liver cirrhosis was also associated with ICU mortality (aOR 144, 95% CI 1.38 to 1.51) and one-year mortality (aOR 1.40, 95% CI 1.35 to 1.46). Associations between cirrhosis of liver and increased 30-day mortality were significant in both sexes and every age group. CONCLUSIONS: Liver cirrhosis was associated with 30-day mortality in ICU patients. Jaundice, ascites, hepatic coma, more than 4 admissions due to cirrhosis, and more than 30 days of hospital stay due to cirrhosis were exacerbated factors in cirrhotic ICU patients.
BACKGROUND: The impact of liver cirrhosis on the outcomes of admission to intensive care unit (ICU) is not completely understood. Our purpose is to identify risk factors for mortality in ICU patients with liver cirrhosis. METHODS: Using reimbursement claims from Taiwan's National Health Insurance Research Database from in 2006-2012, 1,250,300 patients were identified as having ICU stays of more than 1 day, and 37,197 of these had liver cirrhosis. With propensity score-matching for socioeconomic status, pre-existing medical conditions, and cirrhosis-related morbidities, 37,197 ICU patients without liver cirrhosis were selected for comparison. Adjusted odds ratios (ORs) and 95% confidence intervals (CIs) of cirrhosis associated with 30-day, ICU, and one-year mortality were calculated. RESULTS: Compared with control, cirrhoticpatients had higher 30-day mortality (aOR 1.60, 95% CI 1.53 to 1.68), particularly those with jaundice (aOR 2.23, 95% CI 2.03 to 2.45), ascites (aOR 2.32, 95% CI 2.19 to 2.46) or hepatic coma (aOR 2.21, 95% CI 2.07 to 2.36). Among ICU patients, liver cirrhosis was also associated with ICU mortality (aOR 144, 95% CI 1.38 to 1.51) and one-year mortality (aOR 1.40, 95% CI 1.35 to 1.46). Associations between cirrhosis of liver and increased 30-day mortality were significant in both sexes and every age group. CONCLUSIONS:Liver cirrhosis was associated with 30-day mortality in ICU patients. Jaundice, ascites, hepatic coma, more than 4 admissions due to cirrhosis, and more than 30 days of hospital stay due to cirrhosis were exacerbated factors in cirrhotic ICU patients.
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Keywords:
Intensive care unit; Liver cirrhosis; Mortality