Characteristics, Outcomes and Cost Patterns of Patients with Liver Disease Admitted to the Intensive Care Unit
CCCF ePoster library. Fernando S. Oct 4, 2017; 198200; 104
Dr. Shannon Fernando
Dr. Shannon Fernando
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Characteristics, Outcomes and Cost Patterns of Patients with Liver Disease Admitted to the Intensive Care Unit

Fernando, Shannon M., MD, MSc1,2; Reardon, Peter M., MD1,2; Kelly, Erin M., MD, MSc3; Thavorn, Kednapa, PhD4; Kyeremanteng, Kwadwo, MD, MHA1,5

1. Division of Critical Care, Department of Medicine, University of Ottawa, Ottawa, Canada; 2. Department of Emergency Medicine, University of Ottawa, Ottawa, Canada; 3. Division of Gastroenterology and Hepatology, Department of Medicine, University of Ottawa, Ottawa, Canada; 4. Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada; 5. Division of Palliative Medicine, Department of Medicine, University of Ottawa.



 


Background: Patients with chronic and acute liver disease may develop complications requiring admission to the Intensive Care Unit (ICU). Furthermore, chronic liver disease is a significant predictor of ICU morbidity and mortality in other disease processes. At present, little is known regarding the characteristics and cost patterns of patients with liver disease that are admitted to the ICU.     
 
Objectives: We evaluated ICU patient records in order to identify characteristics, outcomes and cost patterns for patients with liver disease admitted to the ICU, regardless of the reason for admission, or the ultimate diagnosis.   
 
Methods: This retrospective cohort study was performed in two tertiary care hospital ICUs, within The Ottawa Hospital network. Patients were enrolled between January 1, 2011 and December 31, 2014. Patient characteristics and outcomes were gathered from The Ottawa Hospital Data Warehouse. Patients with an existing diagnosis of chronic or acute liver disease were identified at the time of ICU admission. Patients who developed new-onset liver disease over the course of their ICU admission were excluded. Primary outcomes were ICU length of stay (LOS) and hospital costs. For cost analysis, the total cost per patient was measured and stored by the hospital Data Warehouse.
 
Results: 8502 patients were admitted to the ICU during the study period, of which 434 (5.1%) had an existing diagnosis of acute or chronic liver disease at the time of ICU admission. Mean age of liver disease patients was 59.4 years (58.3-60.5), and 60.6% were male. Mean Elixhauser Comorbidity Index was 15.6 (15.1-16.2). The most common ICU diagnoses in this cohort were sepsis (n = 82, 18.9%) and decompensated liver disease (n = 58, 13.4%). Overall mortality was 43.5%, with a mean ICU LOS of 8.5 days (7.6-9.4). Cost analysis of this cohort revealed a mean total cost of $55737 (47112-63761) and a mean cost per day of $3652 (3458-3847).
 
Conclusions: Existing acute or chronic liver disease is associated with high mortality and prolonged ICU LOS in our population. Decompensated liver disease only accounts for a minority of ICU admissions in these patients. We also found that patients with liver disease admitted to the ICU are associated with significant healthcare costs. These factors should be considered when admitting patients with existing liver disease to the ICU.

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