Article Highlights
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Aim
To determine the short-term outcomes of patients with alcohol-associated cirrhosis (ALC) admitted to the intensive care unit (ICU) compared with other etiologies of liver disease.
Additionally, we investigated whether rapid sequential assessment of organ failure accurately predicts the presence of sepsis and in-hospital mortality in critically ill patients with various etiologies of cirrhosis.
Methods
A retrospective cohort of 1174 consecutive patients with cirrhosis admitted to the ICU between January 2006 and December 2015 was analyzed. Outcomes of interest included survival rates within the ICU, after ICU in hospital, or at 30 days. after discharge from the ICU.
Results
Five hundred and seventy-eight patients were found to have ALC with 596 in the non-ALC group. There were no significant differences in ICU mortality rates in the ALC vs. non-ALC cohorts (10.2% vs. 11.7%, p = 0.40).
However, ALC patients had significantly higher post-ICU in-hospital death (10.0% vs 6.5%, p = 0.04) as well as higher 30-day post-discharge mortality. from the ICU (18.7% vs. 11.2%, p < 0.00). 001).
Sustained abstinence from alcohol did not offer a survival advantage over non-abstinence.
The predictive power for rapid sequential assessment of organ failure for sepsis and in-hospital mortality for patients with cirrhosis was limited.
Conclusion
Critically ill patients with ALC have poorer survival after ICU discharge compared to patients with other etiologies of cirrhosis, regardless of alcohol abstinence.
Comments
Patients with alcohol-associated cirrhosis have worse outcomes after discharge from the ICU, compared with patients with cirrhosis related to other causes, according to new research from Mayo Clinic.
Cirrhosis is scarring of the liver that impairs function and can be life-threatening. Nearly half of all deaths from cirrhosis are attributed to chronic alcohol use disorder, and the remainder are due to hepatitis and other forms of liver disease.
More than 7 deaths per 100,000 worldwide are related to alcohol-related cirrhosis.
According to the new study published in Mayo Clinic Proceedings, patients with alcohol-associated cirrhosis had a significantly higher in-hospital mortality rate after ICU (10% vs. 6.5%), as well as higher mortality at the 30-day baseline after ICU discharge ― 18.7% vs. 11.2% ― than patients with cirrhosis attributed to other causes.
"Clinical outcomes for patients with alcohol-associated cirrhosis have been reported in previous studies, with conflicting results," says Douglas Simonetto, MD, a Mayo Clinic gastroenterologist and lead author of the study. "Our study demonstrates that although there is no significant difference in ICU mortality in patients with ALC, compared to other causes, there was a significant difference in mortality in patients who survived their ICU stay up to 30 days later. ".
Previous studies have attributed a higher prevalence of infection as the reason for increased mortality in patients with alcohol-associated cirrhosis, compared to patients without alcohol-associated cirrhosis.
"In our study, infection rates were similar between the two groups," says Dr. Simonetto. "But when infection was present, it was associated with higher mortality in LAC."
The retrospective study analyzed the case files of 1,174 patients who were admitted to the Mayo Clinic ICU between January 2006 and December 2015. Patients were divided evenly between those with alcohol-related cirrhosis and those with other-related cirrhosis. Causes. The researchers focused on survival rates within the ICU, after the ICU and in the hospital, and at 30 days after discharge from the ICU.
The average age of study patients was 59 years and 60% were men. Among patients with alcohol-associated cirrhosis, 69.2% had cirrhosis caused by alcohol consumption alone and 30.8% had cirrhosis due to alcohol plus an additional cause, such as viral hepatitis C.
About half of the patients with alcohol-related cirrhosis continued drinking until the end of the week. admission to the ICU, while 36.7% dropped out six months or more before admission.
"Surprisingly, there was no significant difference in survival between patients who abstained from alcohol six months or more before ICU admission and those who did not," says Chansong Choi, MD, a Mayo internal medicine resident. Clinic and lead author of the study.
"This may reflect too short a period of abstinence, as other studies have suggested that at least one to one and a half years of abstinence may be needed to make a significant difference in survival outcomes in patients with ALC."
Early diagnosis of sepsis , a life-threatening condition that occurs when the body’s response to infection damages its own tissues, is critical in patients with cirrhosis who are admitted to the ICU.
Rapid sequential (sepsis-related) organ failure assessment (qSOFA) has been proposed as a simple tool for early detection of sepsis, but Mayo Clinic study finds that qSOFA has limited clinical utility and applicability for patients with cirrhosis.
"Our study finds that qSOFA is a poor predictor of sepsis and in-hospital mortality among patients with cirrhosis," says Dr. Choi. "We need better bedside tools to predict infections and sepsis in these patient groups so we can implement appropriate therapeutic measures."
