The following is a summary of “Critical care outcomes in decompensated cirrhosis: a United States national inpatient sample cross-sectional study,” published in the May 2024 issue of Critical Care by Goble et al.
Researchers conducted a retrospective study to address inconsistencies in prior findings and provide nationally representative data on critical care outcomes for patients with decompensated cirrhosis.
They conducted a retrospective analysis using the National Inpatient Sample from 2016 to 2019. Inclusion criteria encompassed adults with cirrhosis needing respiratory intubation, central venous catheter placement, or both (n=12,945), with principal diagnoses such as esophageal variceal hemorrhage (EVH, 24%), hepatic encephalopathy (58%), hepatorenal syndrome (HRS, 14%), or spontaneous bacterial peritonitis (4%). Additionally, a comparison group consisted of patients lacking cirrhosis who required intubation or central line placement for any principal diagnosis.
The results showed that those with cirrhosis (mean 58 vs. 63 years, P<0.001) had a higher male prevalence (62% vs. 54%, P<0.001). In-hospital mortality was elevated in the cirrhosis cohort (33.1% vs. 26.6%, P<0.001), ranging from 26.7% in EVH to 50.6% in HRS. When renal replacement therapy was used (n = 1,580, 12.2%), mortality was 46.5% in the cirrhosis cohort, compared to 32.3% in other hospitalizations (P<0.001), with the lowest in EVH (25.7%) and the highest in HRS (51.5%). Mortality with cardiopulmonary resuscitation was higher in the cirrhosis cohort (88.0% vs. 72.1%, P< 0.001), peaking in HRS (95.7%).
Investigators found that nationally in the U.S., a third of patients with cirrhotic critically ill didn’t survive hospitalization. However, outcomes were better than previously reported despite being worse than those of non-cirrhotic patients.
Source: ccforum.biomedcentral.com/articles/10.1186/s13054-024-04938-8
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