Profile and Outcome of Patients With Liver Cirrhosis Requiring Mechanical Ventilation
| Autor: | Palepu B Gopal, Dharmesh Kapoor, Ravichandra Raya, Mohan Sathyanarayanan, Deven Juneja |
|---|---|
| Rok vydání: | 2011 |
| Předmět: |
Liver Cirrhosis
Male Mechanical ventilation medicine.medical_specialty Univariate analysis Cirrhosis APACHE II business.industry medicine.medical_treatment Critical Care and Intensive Care Medicine medicine.disease Respiration Artificial Surgery Liver disease Treatment Outcome Primary outcome Health evaluation Internal medicine medicine Humans Intubation business |
| Zdroj: | Journal of Intensive Care Medicine. 27:373-378 |
| ISSN: | 1525-1489 0885-0666 |
| DOI: | 10.1177/0885066611400277 |
| Popis: | Objective: Few studies have addressed the outcome of patients with cirrhosis requiring mechanical ventilation (MV). We aimed to investigate the short-term outcome of such patients. Methods: Retrospective review of data of 73 consecutive patients with cirrhosis requiring MV over a 2-year period (2006-2008). Data on patient’s characteristics, reason for MV, the presence of other organ failure, and first day Acute Physiology Chronic Health Evaluation (APACHE) II, Sequential Organ Failure Assessment (SOFA), Child-Pugh (CP), and Model for End-Stage Liver Disease (MELD) scores were collected, with 30-day mortality being the primary outcome measure. Results: Observed mortality in ICU and at 30 days was 75.3% and 87.7%, respectively. Area under curve was 0.77 (95% CI, 0.65-0.86) for APACHE II, 0.94 (95% CI, 0.85-0.98) for SOFA, 0.83 (95% CI, 0.7-0.96) for CP, and 0.93 (95% CI, 0.85-0.98) for MELD ( P = .096) in predicting 30-day mortality. By univariate analysis, indication for intubation ( P = .001), need for vasopressor support ( P = .002), the presence of renal failure ( P < .03), and duration of MV ( P < .001) were significantly associated with mortality. On multivariate analysis, only duration of MV (adjusted odds ratio 0.63, 95% CI: 0.42-0.95, P = .03) was the independent predictor of mortality with a majority of patients, 51/64 (79.7%), dying in the first 48 hours of intubation. Conclusions: Patients with cirrhosis requiring MV have a dismal prognosis. Such patients and their families should be informed about the overall outcome to assist their decisions about life support and intensive care, outside the transplant setting. Prognostic scores, especially SOFA and MELD, may aid in determining which patients may benefit from aggressive therapy. |
| Databáze: | OpenAIRE |
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