The effect of cirrhosis on trauma outcomes: A systematic review and meta-analysis
| Autor: | Pingyang Liu, Catherine Juillard, Adaobi Nwabuo, Elina Serrano, Simone Langness |
|---|---|
| Rok vydání: | 2019 |
| Předmět: |
Liver Cirrhosis
medicine.medical_specialty Cirrhosis medicine.medical_treatment Critical Care and Intensive Care Medicine Severity of Illness Index law.invention 03 medical and health sciences 0302 clinical medicine law Internal medicine Severity of illness medicine Humans Hospital Mortality Mechanical ventilation business.industry Mortality rate 030208 emergency & critical care medicine Odds ratio Length of Stay medicine.disease Respiration Artificial Intensive care unit Confidence interval Intensive Care Units Meta-analysis Wounds and Injuries Surgery business |
| Zdroj: | Journal of Trauma and Acute Care Surgery. 88:536-545 |
| ISSN: | 2163-0763 2163-0755 |
| Popis: | Background The negative effect of cirrhosis on mortality following traumatic injury has been quantified in multiple observational studies. However, to our knowledge, the information contained in these studies has never been synthesized. The aims of this study were: (1) to determine the magnitude of the effect of liver cirrhosis on mortality, morbidity, and hospital course among trauma patients and (2) to analyze sources of study heterogeneity that may lead to differing estimates in the observed mortality rate among patients with cirrhosis. Methods A systematic search of EMBASE and PubMed was conducted. Data were extracted from eligible studies and analyzed using a random-effects model to compare trauma outcomes in cirrhotic and noncirrhotic patients (PROSPERO Registration CRD42018088464). Mortality was the primary outcome. Secondary outcomes included complication rate, length of hospital stay, length of intensive care unit stay, and mechanical ventilation days. Results Title and abstract review of 15,958 articles led to the identification of 31 relevant articles. Ultimately, 18 observational studies were included in this meta-analysis. The pooled effect sizes for mortality (odds ratio [OR], 4.52; 95% confidence interval [CI], 3.13-6.54) and complication rate (OR, 1.92; 95% CI, 1.30-2.85) were higher in the cirrhotic group than the noncirrhotic group. Trauma patients with cirrhosis also incurred longer hospital stays (mean difference, 3.81 days; 95% CI, 1.22-6.41) and longer ICU stays (mean difference, 2.40 days; 95% CI, 0.65-4.15). There was no difference in days spent on mechanical ventilation. Conclusion Preexisting liver cirrhosis is associated with increased mortality rate, complication rate, and length of hospitalization among trauma patients, even after adjusting for confounding factors and potential sources of between-study heterogeneity. Trauma patients with cirrhosis would benefit from heightened surveillance and injury prevention interventions. Level of evidence Systematic review and meta-analysis, level III. |
| Databáze: | OpenAIRE |
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