改善入住重症监护病房的肝硬化患者的预后：一项回顾性研究。
Improvement in the prognosis of cirrhotic patients admitted to an intensive care unit, a retrospective study.
机构信息
AP-HP, Saint-Antoine Hospital, Medical Intensive Care Unit, 184 rue du faubourg, Saint-Antoine, Paris Cedex 12, France.
出版信息
Eur J Gastroenterol Hepatol. 2012 Aug;24(8):897-904. doi: 10.1097/MEG.0b013e3283544816.
OBJECTIVE
To examine how the outcomes of cirrhotic patients admitted to an ICU have changed over time.
METHODS
A retrospective study in a medical ICU during two separate 3-year periods [period 1 (P1): 1995-1998 and period 2 (P2): 2005-2008].
RESULTS
A total of 56 cirrhotic patients were admitted during P1 and 138 during P2, accounting for 2.3 and 4.5% of the total ICU admissions (P<0.01). Patients' characteristics were markedly different between the two periods: previous functional status improved (Knaus scale, A/B/C/D: P1 - 7.1%/53.6%/35.7%/3.6% vs. P2 - 28.2%/47.8%/22.5%/1.5%, P<0.01), the number of comorbidities decreased (Charlson: 1.79±2.22 vs. 1.02±1.40, P=0.02), the severity of cirrhosis increased [Child-Pugh: 8 (7-13) vs. 11 (8-13), P=0.04; Model for End-Stage Liver Disease: 16 (12-28) vs. 22 (15-31), P=0.02], and acute organ dysfunctions increased (Sequential Organ Failure Assessment: 7.3±5.6 vs. 11.3±5.5, P<0.01). The crude in-ICU mortality was similar during the two periods (39.3 vs. 41.3%, P=0.92). However, after adjustment for severity, in-ICU mortality was markedly decreased during P2 (odds ratio: 0.36 [0.15; 0.88], P=0.02).
CONCLUSION
Cirrhotic patients admitted to the ICU have an improved outcome despite increased severity of liver disease. This improvement is associated with a higher selection according to their previous functional status and comorbidities.
目的
探讨 ICU 收治的肝硬化患者的预后随时间的变化情况。
方法
回顾性研究于两个不同的 3 年期间在一家医疗 ICU 进行[第 1 期（P1）：1995-1998 年和第 2 期（P2）：2005-2008 年]。
结果
P1 期间共收治 56 例肝硬化患者，P2 期间收治 138 例，占 ICU 总入院人数的 2.3%和 4.5%（P<0.01）。两个时期患者的特征明显不同：既往功能状态改善（Knaus 量表，A/B/C/D：P1-7.1%/53.6%/35.7%/3.6% vs. P2-28.2%/47.8%/22.5%/1.5%，P<0.01），合并症数量减少（Charlson：1.79±2.22 vs. 1.02±1.40，P=0.02），肝硬化严重程度增加[Child-Pugh：8（7-13） vs. 11（8-13），P=0.04；终末期肝病模型：16（12-28） vs. 22（15-31），P=0.02]，急性器官功能障碍增加（序贯器官衰竭评估：7.3±5.6 vs. 11.3±5.5，P<0.01）。两个时期 ICU 病死率相似（39.3% vs. 41.3%，P=0.92）。然而，调整严重程度后，P2 期间 ICU 病死率明显下降（比值比：0.36 [0.15；0.88]，P=0.02）。
结论
尽管肝硬化患者的肝病严重程度增加，但 ICU 收治的肝硬化患者的预后有所改善。这种改善与根据既往功能状态和合并症进行更高选择性的治疗有关。
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