Department of Hepatology, St George's Hospital, Tooting, London, UK.
Aliment Pharmacol Ther. 2010 Jul;32(2):233-43. doi: 10.1111/j.1365-2036.2010.04341.x. Epub 2010 Apr 29.
Hospital admissions for cirrhosis have been increasing in the United Kingdom, leading to increased pressure on intensive care (ICU) services. Outcome data for patients admitted to ICU are currently limited to transplant centre reports, with mortality rates exceeding 70%. These tertiary reports could fuel a negative bias when patients with cirrhosis are reviewed for ICU admission in secondary care.
To determine whether disease severity and mortality rates in non-transplant general ICU are less severe than those reported by tertiary datasets.
A prospective dual-centre non-transplant ICU study. Admissions were screened for cirrhosis and physiological and biochemical data were collected. Disease-specific and critical illness scoring systems were evaluated.
Cirrhosis was present in 137/4198 (3.3%) of ICU admissions. ICU and hospital mortality were 38% and 47%, respectively; median age 50 [43-59] years, 68% men, 72% alcoholic cirrhosis, median Child Pugh Score (CPS) 10 [8-11], Model for End-Stage Liver Disease (MELD) 18 [12-24], Acute Physiology and Chronic Health Evaluation II score (APACHE II) 16 [13-22].
Mortality rates and disease staging were notably lower than in the published literature, suggesting that patients have a more favourable outlook than previously considered. Transplant centre data should therefore be interpreted with caution when evaluating the merits of intensive care admission for patients in general secondary care ICUs.
英国因肝硬化导致的住院人数不断增加，这给重症监护病房（ICU）的服务带来了更大的压力。目前，ICU 收治患者的预后数据仅限于移植中心的报告，死亡率超过 70%。这些三级报告可能会对二级医疗机构审查 ICU 收治患者时产生负面影响，因为报告中可能会夸大肝硬化患者的死亡率。
确定非移植普通 ICU 患者的疾病严重程度和死亡率是否低于三级数据集报告的程度。
一项前瞻性的双中心非移植 ICU 研究。对 ICU 收治的患者进行肝硬化筛查，并收集生理和生化数据。评估了特定疾病和危重病评分系统。
在 4198 例 ICU 收治患者中，有 137 例（3.3%）存在肝硬化。ICU 内和院内死亡率分别为 38%和 47%；中位年龄为 50 岁[43-59]，男性占 68%，酒精性肝硬化占 72%，Child-Pugh 评分（CPS）中位数为 10 [8-11]，终末期肝病模型评分（MELD）为 18 [12-24]，急性生理学和慢性健康评估评分 II（APACHE II）为 16 [13-22]。
死亡率和疾病分期明显低于文献报道，这表明患者的预后比之前认为的更有利。因此，在评估普通二级医疗机构 ICU 患者 ICU 收治的优势时，应谨慎解读移植中心的数据。
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