Department of Internal Medicine 1, Goethe-University Hospital Frankfurt.
Department of Anaesthesiology, Intensive Care Medicine and Pain Therapy, Goethe-University Hospital Frankfurt.
Z Gastroenterol. 2021 Jul;59(7):657-664. doi: 10.1055/a-1401-2387. Epub 2021 Mar 16.
Liver cirrhosis is a systemic disease that substantially impacts the body's physiology, especially in advanced stages. Accordingly, the outcome of patients with cirrhosis requiring intensive care treatment is poor. We aimed to analyze the impact of cirrhosis on mortality of intensive care unit (ICU) patients compared to other frequent chronic diseases and conditions.
In this retrospective study, patients admitted over three years to the ICU of the Department of Medicine of the University Hospital Frankfurt were included. Patients were matched for age, gender, pre-existing conditions, simplified acute physiology score (SAPS II), and therapeutic intervention scoring system (TISS).
A total of 567 patients admitted to the ICU were included in the study; 99 (17.5 %) patients had liver cirrhosis. A total of 129 patients were included in the matched cohort for the sensitivity analysis. In-hospital mortality was higher in cirrhotic patients than non-cirrhotic patients (p < 0.0001) in the entire and matched cohort. Liver cirrhosis remained one of the strongest independent predictors of in-hospital mortality (entire cohort p = 0.001; matched cohort p = 0.03) along with dialysis and need for transfusion in the multivariate logistic regression analysis. Furthermore, in the cirrhotic group, the need for kidney replacement therapy (p < 0.001) and blood transfusion (p < 0.001) was significantly higher than in the non-cirrhotic group. CONCLUSIONS: In the presented study, liver cirrhosis was one of the strongest predictors of in-hospital mortality in patients needing intensive care treatment along with dialysis and the need for ventilation. Therefore, concerted efforts are needed to improve cirrhotic patients' outcomes, prevent disease progression, and avoid complications with the need for ICU treatment in the early stages of the disease.
肝硬化是一种全身性疾病，会对人体生理机能造成严重影响，尤其是在晚期阶段。因此，需要接受重症监护治疗的肝硬化患者的预后通常较差。本研究旨在分析肝硬化对重症监护病房（ICU）患者死亡率的影响，并与其他常见慢性疾病和情况进行比较。
这是一项回顾性研究，纳入了三年内在法兰克福大学医院内科 ICU 接受治疗的患者。患者按照年龄、性别、既往疾病、简化急性生理学评分（SAPS II）和治疗干预评分系统（TISS）进行匹配。
本研究共纳入了 567 名 ICU 患者；其中 99 名（17.5%）患者患有肝硬化。共有 129 名患者纳入敏感性分析的匹配队列。在整个队列和匹配队列中，肝硬化患者的院内死亡率均高于非肝硬化患者（p<0.0001）。在多变量逻辑回归分析中，肝硬化仍然是院内死亡率的最强独立预测因素之一（整个队列 p=0.001；匹配队列 p=0.03），其次是透析和输血的需求。此外，在肝硬化组中，需要肾脏替代治疗（p<0.001）和输血（p<0.001）的比例明显高于非肝硬化组。
在本研究中，肝硬化与透析和需要通气一起，是需要重症监护治疗的患者院内死亡率的最强预测因素之一。因此，需要共同努力改善肝硬化患者的预后，预防疾病进展，并在疾病早期避免并发症和需要 ICU 治疗。
