Department of Gastroenterology, T.N.M.C and B.Y.L Nair Ch. Hospital, Mumbai, India.
Department of General Medicine, T.N.M.C and B.Y.L Nair Ch. Hospital, Mumbai, India.
Arq Gastroenterol. 2022 Apr-Jun;59(2):164-169. doi: 10.1590/S0004-2803.202202000-31.
A large number of patients admitted to the medical intensive care unit (MICU) have abnormal liver function tests (LFT). This includes patients with critical illness with or without preexisting liver disease and patients with acute primary liver injury. There are very few studies which have investigated the spectrum of liver disease, clinical profile and outcome in patients admitted to the MICU.
To evaluate the occurrence, etiology, clinical profile, laboratory profile and outcome of hepatic dysfunction in patients admitted to the MICU. To evaluate the utility of model for end-stage liver disease (MELD) score on admission as a predictor of adverse short term outcome in patients with hepatic dysfunction admitted in MICU.
It was a prospective observational study, conducted from December 2017 to December 2018 in a tertiary care hospital. Two hundred and two patients admitted to the MICU with LFTs as per the inclusion criteria were analyzed and their short-term outcome at 7 days was studied in relation to various parameters.
LFT abnormalities were present in 202/1126 (17.9%) of the patients admitted to MICU. Critical illness associated liver dysfunction was found in 172 (85.2%) patients, chronic liver disease in 11 (5.4%) patients and acute viral hepatitis in 19 (9.4%) patients. Most common symptom was fever (68.3%) followed by vomiting (48.0%). Among LFT abnormalities, elevated transaminases, raised international normalized ratio and high MELD score on admission correlated with poor short-term outcome. Requirement for inotropes and mechanical ventilation correlated with poor short-term outcome. Mortality did not differ significantly between patients with chronic liver disease, patients with acute viral hepatitis and patients with critical illness associated hepatic dysfunction. Hepatic dysfunction in MICU was associated with poor outcome and a high short-term mortality of 56.4% (114/202).
Liver function abnormality is common in patients who are admitted to the MICU and its presence is an indicator of poor short-term outcome.
大量入住内科重症监护病房（MICU）的患者存在肝功能异常（LFT）。这些患者包括患有重症疾病但无或有潜在肝脏疾病的患者以及患有急性原发性肝损伤的患者。只有极少数研究调查了入住 MICU 的患者的肝病谱、临床特征和预后。
评估入住 MICU 的患者肝功能障碍的发生、病因、临床特征、实验室特征和预后。评估入院时终末期肝病模型（MELD）评分作为预测 MICU 中肝功能障碍患者短期不良预后的指标的效用。
这是一项前瞻性观察研究，于 2017 年 12 月至 2018 年 12 月在一家三级保健医院进行。分析了符合纳入标准入住 MICU 且 LFT 异常的 202 例患者，并研究了他们在 7 天时的短期预后与各种参数的关系。
入住 MICU 的 1126 例患者中，有 202 例（17.9%）出现 LFT 异常。172 例（85.2%）患者存在与重症相关的肝功能障碍，11 例（5.4%）患者存在慢性肝病，19 例（9.4%）患者存在急性病毒性肝炎。最常见的症状是发热（68.3%），其次是呕吐（48.0%）。在 LFT 异常中，入院时升高的转氨酶、国际标准化比值升高和较高的 MELD 评分与不良短期预后相关。需要使用血管活性药物和机械通气与不良短期预后相关。慢性肝病、急性病毒性肝炎和与重症相关的肝功能障碍患者之间的死亡率无显著差异。MICU 中的肝功能障碍与不良预后相关，短期死亡率较高（56.4%，114/202）。
入住 MICU 的患者肝功能异常很常见，其存在是短期预后不良的指标。
