Mita Atsuyoshi, Shimizu Sari, Ichiyama Takashi, Yamamoto Takateru, Yamaguchi Akinori, Sonoda Kosuke, Mori Kotaro, Yamada Tomokatsu, Nakamura Hiroyuki, Imamura Hiroshi
Intensive Care Unit, Shinshu University Hospital Shinshu University School of Medicine Matsumoto Japan.
Health Sci Rep. 2024 Mar 10;7(3):e1926. doi: 10.1002/hsr2.1926. eCollection 2024 Mar.
Critically ill patients with liver failure have high mortality. Besides the management of organ-specific complications, liver transplantation constitutes a definitive treatment. However, clinicians may hesitate to introduce mechanical ventilation for patients on liver transplantation waitlists because of poor prognosis. This study investigated the outcomes of intensive care and ventilation support therapy effects in patients with liver failure.
This single-center study retrospectively enrolled 32 consecutive patients with liver failure who were admitted to the intensive care unit from January 2014 to December 2020. The medical records were reviewed and analyzed retrospectively for Acute Physiologic and Chronic Health Evaluation (APACHE)-II. The model for end-stage liver disease scores, 90-day mortality, and survival was assessed using the Kaplan-Meier method.
The average patient age was 45.5 ± 20.1 years, and 53% of patients were women. On intensive care unit admission, APACHE-II and model for end-stage liver disease scores were 20 and 28, respectively. Among 13 patients considered for liver transplantation, 4 received transplants. Thirteen patients (40.6%) were intubated and mechanically ventilated in the intensive care unit. The 90-day mortality rate of patients with and without mechanical ventilation in the intensive care unit (13, 61.5% vs. 19, 47.4%, = 0.4905) was similar. APACHE-II score >21 was an independent predictor of mechanical ventilation requirement in patients with liver failure during intensive care unit stay.
Although critically ill patients with liver failure are at risk of multiorgan failure with poor outcomes, mechanical ventilation did not negatively affect the 90-day mortality or performance rates of liver transplantation. Clinicians should consider mechanical ventilation-based life support in critically ill patients with liver failure who are awaiting liver transplantation.
肝功能衰竭的危重症患者死亡率很高。除了处理器官特异性并发症外，肝移植是一种确定性治疗方法。然而，由于预后不佳，临床医生可能会犹豫是否对列入肝移植等待名单的患者进行机械通气。本研究调查了肝功能衰竭患者的重症监护和通气支持治疗效果。
这项单中心研究回顾性纳入了2014年1月至2020年12月期间连续入住重症监护病房的32例肝功能衰竭患者。回顾并分析病历以计算急性生理与慢性健康状况评分系统（APACHE）-II。使用Kaplan-Meier方法评估终末期肝病模型评分、90天死亡率和生存率。
患者平均年龄为45.5±20.1岁，53%为女性。入住重症监护病房时，APACHE-II和终末期肝病模型评分分别为20分和28分。在13例考虑进行肝移植的患者中，4例接受了移植。13例患者（40.6%）在重症监护病房接受了插管和机械通气。在重症监护病房接受和未接受机械通气的患者90天死亡率（13例，61.5%对19例，47.4%，P = 0.4905）相似。APACHE-II评分>21是肝功能衰竭患者在重症监护病房住院期间需要机械通气的独立预测因素。
尽管肝功能衰竭的危重症患者有发生多器官功能衰竭且预后不良的风险，但机械通气并未对90天死亡率或肝移植成功率产生负面影响。临床医生应考虑对等待肝移植的肝功能衰竭危重症患者进行基于机械通气的生命支持。
