Department of Clinical Pharmacology, University College London, 5 University Street, London WC1E 6JF, UK. a.o'
Intensive Care Med. 2012 Jun;38(6):991-1000. doi: 10.1007/s00134-012-2523-2. Epub 2012 Mar 29.
Patients with decompensated liver cirrhosis who are admitted to intensive care units (ICU) are perceived, within the UK, as having a particularly poor prognosis.
We performed a descriptive analysis of cirrhosis patients admitted to general critical care units 1995-2008 compared to patients admitted with pre-existing chronic renal failure. Data were obtained from the Intensive Care National Audit and Research Centre Case Mix Programme Database incorporating 192 adult critical care units in England, Wales and Northern Ireland.
Cirrhosis accounted for 2.6 % (16,096 patients) of total admissions with mean age 52.5 years and male preponderance (~60 %). Hospital mortality was high (>55 %) although this improved 5 % in recent years, and median length of stay was short (2.5 days). Mortality in cirrhotics with severe sepsis requiring organ support was 65-90 %, compared to 33-39 % in those without. Conversely, patients with chronic renal failure had lower mortality (42 %) despite similar characteristics and higher acute physiology and chronic health evaluation (APACHE) II scores. The APACHE II score under-predicted mortality in cirrhotics.
Cirrhosis patients exhibit worse outcomes compared to pre-existing renal failure patients, despite similar characteristics. Survival worsens considerably with organ failure, especially with sepsis. They represent a small number of admissions, albeit increasing over recent years, and, in general, have a short ICU stay. Patients with single organ failure have acceptable survival rates and mortality has improved; although we have no data on those refused ICU admission potentially causing survival bias. Given the extremely high mortality in patients with multi-organ failure, support should be limited/withdrawn in such patients.
在英国，人们认为失代偿期肝硬化患者入住重症监护病房（ICU）的预后特别差。
我们对 1995 年至 2008 年入住普通重症监护病房的肝硬化患者与因预先存在的慢性肾功能衰竭而入院的患者进行了描述性分析。数据来自英国、威尔士和北爱尔兰的 192 个成人重症监护单位的重症监护国家审计和研究中心病例组合计划数据库。
肝硬化占总入院人数的 2.6%（16096 例），平均年龄为 52.5 岁，男性居多（~60%）。住院死亡率很高（>55%），尽管近年来有所改善（5%），中位住院时间很短（2.5 天）。需要器官支持的严重脓毒症的肝硬化患者死亡率为 65-90%，而无严重脓毒症的患者死亡率为 33-39%。相反，尽管特征相似且急性生理学和慢性健康评估（APACHE）II 评分较高，但患有慢性肾功能衰竭的患者死亡率较低（42%）。APACHE II 评分低估了肝硬化患者的死亡率。
尽管特征相似，但肝硬化患者的预后比预先存在的肾功能衰竭患者差。随着器官衰竭，尤其是脓毒症，生存状况明显恶化。他们的入住人数虽然较少，但近年来呈上升趋势，总体 ICU 住院时间较短。只有单个器官衰竭的患者有可接受的生存率，死亡率有所改善；尽管我们没有关于那些可能因拒绝 ICU 入院而导致生存偏差的数据。鉴于多器官衰竭患者的死亡率极高，应限制/撤回此类患者的支持。
