Department of Gastroenterology, Osmaniye Public Hospital, Raufbey Mahallesi, Osmaniye, Turkey.
Wien Klin Wochenschr. 2012 Aug;124(15-16):520-5. doi: 10.1007/s00508-012-0208-z. Epub 2012 Jul 19.
Cirrhotic patients admitted to the intensive care unit (ICU) usually have multi-organ failure. Multiple organ failure entails a very poor outcome in all intensive care patients. Cirrhotic patients show high morbidity and mortality rates compared with other critically ill patients. Severity scores have been developed for cirrhotic patients admitted to ICU. The main aim of this study was to determine whether lactate level gives any predictive value for mortality in cirrhotic elderly patients admitted to the ICU.
In all the patients enrolled, a diagnosis of cirrhosis was confirmed either histologically or by resorting to clinical, laboratory, and ultrasonographic findings. During this period, patients with cirrhosis were admitted to the ICU with varying indications. Child-Turcotte-Pugh (CTP), Model for End-stage Liver Disease (MELD), Acute Physiology and Chronic Health Evaluation (APACHE II) and Sequential Organ Failure Assessment (SOFA) scores and lactate were compared between deceased and discharged patients.
A total of 90 consenting patients were enrolled in this study. The mean age of all the patients was 69 ± 5.919. We detected etiological factors for cirrhosis as HBV, HCV, alcohol, and cryptogenic cirrhosis. Hepatorenal syndrome and spontaneous bacterial peritonitis were significantly higher in patients who died than in those who were discharged from the ICU (p values were 0.01 and 0.028, respectively). Lactate level, CTP, APACHE II, MELD and SOFA scores were significantly higher in patients who died than in those who were discharged from the ICU (p values were 0.002, < 0.001, < 0.001, and < 0.001, respectively).
Many factors may be useful as a predictor of mortality in ICU in elderly patients with cirrhosis. In terms of prognostic value, the lactate level and APACHE II score are the two best predictive factors in cirrhotic elderly patients admitted to the ICU.
入住重症监护病房（ICU）的肝硬化患者通常有多器官衰竭。多器官衰竭会导致所有 ICU 患者的预后非常差。与其他危重病患者相比，肝硬化患者的发病率和死亡率都很高。为入住 ICU 的肝硬化患者开发了严重程度评分。本研究的主要目的是确定乳酸水平是否对入住 ICU 的老年肝硬化患者的死亡率有预测价值。
所有纳入的患者均通过组织学或临床、实验室和超声检查结果确诊为肝硬化。在此期间，不同适应症的肝硬化患者入住 ICU。Child-Turcotte-Pugh（CTP）、终末期肝病模型（MELD）、急性生理学和慢性健康评估（APACHE II）和序贯器官衰竭评估（SOFA）评分和乳酸在死亡和出院患者之间进行比较。
本研究共纳入 90 例同意的患者。所有患者的平均年龄为 69±5.919 岁。我们检测到肝硬化的病因因素为 HBV、HCV、酒精和隐源性肝硬化。肝肾综合征和自发性细菌性腹膜炎在死亡患者中明显高于出院患者（p 值分别为 0.01 和 0.028）。死亡患者的乳酸水平、CTP、APACHE II、MELD 和 SOFA 评分明显高于出院患者（p 值分别为 0.002、<0.001、<0.001 和 <0.001）。
许多因素可能有助于预测老年肝硬化患者 ICU 的死亡率。在预后价值方面，乳酸水平和 APACHE II 评分是入住 ICU 的肝硬化老年患者两个最佳预测因素。
