Gildea Thomas R, Cook William C, Nelson David R, Aggarwal Anjana, Carey William, Younossi Zobair M, Arroliga Alejandro C
Department of Pulmonary and Critical Care Medicine, The Cleveland Clinic Foundation, 9500 Euclid Ave, G62, Cleveland, OH 44195, USA.
Chest. 2004 Nov;126(5):1598-603. doi: 10.1378/chest.126.5.1598.
The long-term survival of patients with cirrhosis of the liver admitted to the ICU has not been described.
The main objectives were to determine the 1-year and 5-year mortality rates of a cohort of patients admitted to a medical ICU (MICU), and to identify the risk factors that may predict long-term outcomes.
This is a cohort study. We used a model-building (MB) and model validation (MV) procedure that has previously been described to determine the risk factors for overall mortality.
An MICU in a major referral medical center.
Four hundred twenty consecutive patients admitted to the ICU from January 1, 1993, through October 31, 1998, met the inclusion criteria of diagnosis of liver failure, cirrhosis, chronic liver disease, variceal bleeding, hepatic encephalopathy, or hepatorenal syndrome. Patients with acute liver failure who had undergone liver transplantation, or candidates for orthotopic liver transplantation were excluded.
None.
The 1-year mortality rate was 69%, and the 5-year mortality rate was 77%. The median survival time was 1 month. The independent predictors of mortality in patients in the MB group who retained their significance in the MV group were as follows: an acute physiology, age, and chronic health evaluation (APACHE) III score of >/= 90 (hazard ratio [HR], 2.2; 95% confidence interval [CI], 1.6 to 2.8; p < 0.0001), the use of pressors (HR, 2.5; 95% CI, 1.9 to 3.2; p < 0.0001), and jaundice (HR, 1.7; 95% CI, 1.4 to 2.2; p < 0.0001). Patients with all three risk factors (ie, APACHE III score >/= 90, use of pressors, and jaundice) had a 92% 1-month mortality rate compared to 11.2% for patients with no risk factors.
Patients admitted to an MICU with underlying cirrhosis who are not eligible for liver transplantation have a poor long-term prognosis, even if they survive the ICU admission, particularly as the number of risk factors increases.
入住重症监护病房（ICU）的肝硬化患者的长期生存率尚未见报道。
主要目的是确定入住内科重症监护病房（MICU）的一组患者的1年和5年死亡率，并确定可能预测长期预后的危险因素。
这是一项队列研究。我们采用了先前描述的模型构建（MB）和模型验证（MV）程序来确定总体死亡率的危险因素。
一家大型转诊医疗中心的MICU。
1993年1月1日至1998年10月31日连续入住ICU的420例患者符合肝衰竭、肝硬化、慢性肝病、静脉曲张出血、肝性脑病或肝肾综合征诊断的纳入标准。接受过肝移植的急性肝衰竭患者或原位肝移植候选人被排除在外。
无。
1年死亡率为69%，5年死亡率为77%。中位生存时间为1个月。在MB组中对死亡率有独立预测作用且在MV组中仍具有显著性的因素如下：急性生理学、年龄和慢性健康评估（APACHE）III评分≥90（风险比[HR]，2.2；95%置信区间[CI]，1.6至2.8；p<0.0001），使用升压药（HR，2.5；95%CI，1.9至3.2；p<0.0001），以及黄疸（HR，1.7；95%CI，1.4至2.2；p<0.0001）。具有所有三个危险因素（即APACHE III评分≥90、使用升压药和黄疸）的患者1个月死亡率为92%，而无危险因素的患者为11.2%。
入住MICU且有潜在肝硬化但不符合肝移植条件的患者，即使在ICU住院期间存活，长期预后也很差，尤其是随着危险因素数量的增加。
