Castera L, Pauwels A, Lévy V G
Service d'Hépato-Gastroentérologie, Hôpital Saint-Antoine, Paris.
Gastroenterol Clin Biol. 1996;20(3):263-8.
Assessment of prognosis in patients with cirrhosis admitted to an Intensive Care Unit remains unsatisfactory. The aims of this retrospective study were to determine the survival rates of patients admitted to an Intensive Care Unit, and to identify and validate prognostic indicators associated with a high mortality rate.
Two hundred and forty three patients with cirrhosis consecutively admitted to the Intensive Care Unit were studied. The main reasons for admission were upper gastrointestinal bleeding (n = 163), coma (n = 43), sepsis (n = 18), and liver failure (n = 13). Patients were divided into two groups: group 1 (n = 121) to identify prognostic indicators associated with a high mortality rate, and group 2 (n = 122) to validate these indicators.
Intensive Care Unit and one year survival rates of patients with cirrhosis admitted for upper gastrointestinal hemorrhage were 76 and 50% respectively. These rates were 40 and 8% respectively for patients admitted for other reasons. In group 1, 4 predictive factors found at admission were identified to have independent significance by stepwise logistic regression: grade III or IV encephalopathy, prothrombin index, serum creatinine, and hypoxemia. On the other hand, the presence of shock on admission was associated with a 100% mortality rate. Two prognostic indicators were defined: shock requiring the administration of vasoactive drugs, and the presence of 3 out of the 4 following predictive factors: grade III or IV encephalopathy, mechanical ventilation, prothrombin index < 30%, and serum creatinine > 130 mumol/L. In group 2, the presence of at least one prognostic indicator at admission or during intensive care was associated with a 96% mortality rate. These indicators were present in 69% of patients who died. In 17 patients who died, but survived more than 24 hours in the Intensive Care Unit, indicators were present an average of 6.0 +/- 5.3 days before death.
Common prognostic indicators may accurately predict death in patients with cirrhosis admitted to an Intensive Care Unit. These indicators could be helpful in identifying patients who will not benefit from intensive care.
对入住重症监护病房的肝硬化患者的预后评估仍不尽人意。这项回顾性研究的目的是确定入住重症监护病房患者的生存率，并识别和验证与高死亡率相关的预后指标。
对连续入住重症监护病房的243例肝硬化患者进行研究。入院的主要原因是上消化道出血（n = 163）、昏迷（n = 43）、败血症（n = 18）和肝衰竭（n = 13）。患者分为两组：第1组（n = 121）用于识别与高死亡率相关的预后指标，第2组（n = 122）用于验证这些指标。
因上消化道出血入院的肝硬化患者的重症监护病房生存率和一年生存率分别为76%和50%。因其他原因入院的患者的这些比率分别为40%和8%。在第1组中，通过逐步逻辑回归确定入院时发现的4个预测因素具有独立意义：III级或IV级脑病、凝血酶原指数、血清肌酐和低氧血症。另一方面，入院时出现休克与100%的死亡率相关。定义了两个预后指标：需要使用血管活性药物的休克，以及以下4个预测因素中出现3个：III级或IV级脑病、机械通气、凝血酶原指数<30%和血清肌酐>130μmol/L。在第2组中，入院时或重症监护期间至少存在一个预后指标与96%的死亡率相关。这些指标在69%的死亡患者中存在。在17例死亡但在重症监护病房存活超过24小时的患者中，指标在死亡前平均出现6.0±5.3天。
常见的预后指标可准确预测入住重症监护病房的肝硬化患者的死亡。这些指标有助于识别那些无法从重症监护中获益的患者。
