Department of Gastroenterology, The Alfred Hospital, Melbourne, Australia; AW Morrow Gastroenterology and Liver Centre, Royal Prince Alfred Hospital, Sydney, Australia.
Australian and New Zealand Intensive Care Research Centre (ANZIC RC), Department of Epidemiology and Preventive Medicine, Monash University, Australia; ANZICS Centre for Outcome and Resource Evaluation (CORE), Melbourne, Australia.
J Hepatol. 2017 Dec;67(6):1185-1193. doi: 10.1016/j.jhep.2017.07.024. Epub 2017 Aug 9.
BACKGROUND & AIMS: Few studies have described the outcomes of patients with cirrhosis receiving intensive care unit (ICU) admission at a population level. We aimed to describe trends in the mortality of such patients in Australia and New Zealand (ANZ), and to investigate the relationship with associated organ failures.
We studied patients admitted to 172 ICUs on a non-elective basis, with and without cirrhosis between January 1st 2000 and December 31st 2015, as recorded by the ANZ Intensive Care Society Centre for Outcome and Resource Evaluation Adult Patient Database. We assessed severity of illness on admission using organ failure models and acute physiology scores. The primary outcome was hospital mortality.
Patients with cirrhosis accounted for 17,044 of 776,873 non-elective ICU admissions (2.2%). Cirrhosis hospital mortality was 32.4% compared to 16.9% in the non-cirrhotic group (p<0.0001). After adjustment for key confounders, cirrhosis had an independent effect on mortality with an odds ratio (OR) of 1.10 (1.06-1.15). There was no difference in the adjusted annual decline in mortality between patients with or without cirrhosis (OR 0.96 [0.95-0.97] vs. 0.96 [0.96-0.96], p=0.67). No difference was seen in the adjusted decline in mortality of patients with cirrhosis when stratified by mechanical ventilation (p=0.92), liver transplant centre status (p=0.27) or presence of sepsis (p=0.09). Mortality increased with number of organ failures, however, the presence of cirrhosis was not found to affect this relationship (p=0.33).
The mortality of patients with cirrhosis admitted to ICU on a non-elective basis has declined significantly over time, comparable to patients without cirrhosis, and is predominantly governed by the number of organ failures. Outcomes are similar between non-liver transplant ICUs and liver transplant centres.
The outcomes of patients with liver cirrhosis admitted to intensive care units (ICUs) have been previously regarded as poor. We have demonstrated that in Australia and New Zealand, annual in-hospital death rates following ICU admission in this patient group are lower than previously reported, have improved over 16years to 29% and are at a rate similar to patients without cirrhosis. Our data justify recommendations that advocate better access to intensive care for patients with cirrhosis.
很少有研究描述过在人群水平上接受重症监护病房（ICU）入院治疗的肝硬化患者的结局。我们旨在描述澳大利亚和新西兰（ANZ）此类患者死亡率的趋势，并研究其与相关器官衰竭的关系。
我们研究了 2000 年 1 月 1 日至 2015 年 12 月 31 日期间，在非选择性基础上入住 172 个 ICU 的患者，记录了有无肝硬化。澳大利亚和新西兰重症监护学会中心对结果和资源评估成人患者数据库。我们使用器官衰竭模型和急性生理学评分来评估入院时的严重程度。主要结局是住院死亡率。
肝硬化患者占 776873 例非选择性 ICU 入院患者的 17044 例（2.2%）。与非肝硬化组相比，肝硬化患者的住院死亡率为 32.4%（p<0.0001）。调整关键混杂因素后，肝硬化对死亡率的独立影响为 1.10（1.06-1.15）。有无肝硬化患者的死亡率呈逐年下降趋势无差异（调整后比值比（OR）0.96 [0.95-0.97] vs. 0.96 [0.96-0.96]，p=0.67）。分层后，机械通气（p=0.92）、肝移植中心状态（p=0.27）或脓毒症（p=0.09）的肝硬化患者死亡率下降无差异。死亡率随器官衰竭数量的增加而增加，但肝硬化的存在并未影响这种关系（p=0.33）。
在非选择性基础上入住 ICU 的肝硬化患者的死亡率随着时间的推移显著下降，与无肝硬化患者相似，主要由器官衰竭的数量决定。非肝移植 ICU 和肝移植中心的结果相似。
以前认为，肝硬化患者接受重症监护病房（ICU）治疗的结局较差。我们证明，在澳大利亚和新西兰，该患者组 ICU 入院后 1 年内的住院死亡率低于以前的报告，16 年来已降至 29%，与无肝硬化患者相似。我们的数据证明了提倡为肝硬化患者提供更好的 ICU 服务的建议是合理的。
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