Tariparast Pischtaz Adel, Roedl Kevin, Horvatits Thomas, Drolz Andreas, Kluge Stefan, Fuhrmann Valentin
Department of Intensive Care Medicine, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany.
Department of Medicine I, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
Sci Rep. 2025 Feb 4;15(1):4301. doi: 10.1038/s41598-025-88606-z.
We investigated the occurrence and outcome of respiratory failure and ARDS in critically ill patients with liver cirrhosis. This is a retrospective analysis of patients with liver cirrhosis at an ICU during an 8-Year period. An assessment of acute on chronic liver failure as well as the presence and grade of ARDS within the first 72 h of admission to the ICU was performed. A total of 735 patients during the study period. Median age was 58 (50-69) years and 61% (n = 447) were male. 57% (n = 421) of the patients received mechanical ventilation (MV). Liver specific as well as ICU scores on admission were significantly higher in patients with MV. Necessity of vasopressor support (86%vs.25%, p < 0.001) and RRT (50%vs.11%, p < 0.001) was more frequent in patients with MV. The incidence of ARDS within the first 72 h of admission was 8% (n = 61). We observed a 28-day mortality or liver transplantation rate of 54% (n = 196) and 66% (n = 66%) in patients with MV and ARDS, respectively. After 90-days 63% (n = 226) with MV and 70% (n = 43) with ARDS were dead or received liver transplantation. ARDS is a prognostic factor for mortality in patients with liver cirrhosis admitted to the ICU. One out of ten critically ill cirrhotic patients develop ARDS within 72 h after admission. Although mortality rates are high initially critical care therapy should not be withheld and must be reevaluated regularly.
我们调查了肝硬化重症患者呼吸衰竭和急性呼吸窘迫综合征（ARDS）的发生情况及转归。这是一项对某重症监护病房（ICU）8年间肝硬化患者的回顾性分析。对慢性肝衰竭急性发作以及入住ICU后72小时内ARDS的存在情况及分级进行了评估。研究期间共有735例患者。中位年龄为58（50 - 69）岁，61%（n = 447）为男性。57%（n = 421）的患者接受了机械通气（MV）。接受MV的患者入院时肝脏特异性指标以及ICU评分显著更高。MV患者使用血管活性药物支持的必要性（86%对25%，p < 0.001）和肾脏替代治疗（RRT）的必要性（50%对11%，p < 0.001）更为常见。入院后72小时内ARDS的发生率为8%（n = 61）。我们观察到接受MV和ARDS患者的28天死亡率或肝移植率分别为54%（n = 196）和66%（n = 66%）。90天后，接受MV的患者中有63%（n = 226）以及患有ARDS的患者中有70%（n = 43）死亡或接受了肝移植。ARDS是入住ICU的肝硬化患者死亡率的一个预后因素。十分之一的肝硬化重症患者在入院后72小时内发生ARDS。尽管初始死亡率很高，但不应停止重症监护治疗，且必须定期重新评估。
