Outcomes and Costs of Patients with Cirrhosis Admitted to Intensive Care Unit
CCCF ePoster library. Dave C. 11/12/19; 283426; EP67
Dr. Chintan Dave
Dr. Chintan Dave
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Abstract
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ePoster
Topic: Retrospective or Prospective Cohort Study or Case Series

Dave, Chintan1, Wan, Cynthia2, Fernando, Shannon F.2, Kelly, Erin3, Thompson, Laura H.2, Tanuseputro, Peter4,5,6,7, Kyeremanteng, Kwadwo2,5,7
1Department of Medicine, The Ottawa Hospital, Ottawa, ON, Canada
2Division of Critical Care Medicine, Department of Medicine, The Ottawa Hospital, Ottawa, ON, Canada
3Department of Gastroenterology, The Ottawa Hospital, Ottawa, ON, Canada
4Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada.
5School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada
6Bruyere Research Institute, Ottawa, ON, Canada.
7Division of Palliative Care, Department of Medicine, University of Ottawa, Ottawa, ON, Canada.


Background: Cirrhosis comprises a significant burden on the healthcare care system in North America, both in the acute care setting and as a chronic disease. Commonly, acute deterioration of patients with cirrhosis manifests as multi-organ failure requiring admission to the Intensive Care Unit (ICU).  These patients admitted to the ICU have a high mortality and have poor outcomes when compared to hospital patients with cirrhosis who do not require ICU admission. Due to the advancement of the standard of care, mortality rates for patients with cirrhosis has improved in the past 20 years; however, much of the mortality rate is still comprised of cirrhosis patients admitted to the ICU. There is a paucity of evidence about the factors that lead to increased mortality and cost in patients with cirrhosis who are admitted to the ICU.
Objectives: To identify the prognostic risk factors and outcomes for patients with cirrhosis admitted to the ICU and to evaluate cost patterns.
Methods: We conducted a retrospective cohort analysis of a health administrative database, consisting of patient data from two ICUs within a single hospital system. The sample consisted of 8,447 patients admitted to ICU from 2011 to 2014, of whom 332 had a diagnosis of cirrhosis. Control patients were defined as randomly selected age, sex, and comorbidity index–matched ICU patients without cirrhosis (1:4 matching ratio).
Results: Mean age of cirrhosis patients in the ICU was 59.6 years, and 131 (39.5%) died prior to discharge. As compared to cirrhotics who lived, patients with cirrhosis who died were more likely to have a high average bilirubin (65.5 vs. 106.5; p<0.001), lactate (3.8 vs. 6.5; p<0.001), INR (1.72 vs. 2.19; p<0.001), and an increased need for red blood cells transfusions (54.7% vs. 72.8%; p<0.001) during their hospital stay. The cirrhosis-related complications that most frequently brought cirrhosis patients to the ICU were ascites (31.1%), encephalopathy (18.9%), and peritonitis (14.4%). Cirrhosis patients with peritonitis (8.8% vs. 21.2%; p<0.001) and hepatorenal syndrome (2.8% vs. 13.9%; p<0.001) were more likely to die in the ICU compared to cirrhosis patients admitted with other diagnoses. Results from further analysis of prognostic markers comparing cirrhosis patients and controls, as well as cost analyses will be reported with the final abstract presentation.
Conclusion: Our findings illustrate that cirrhosis patients admitted to the ICU have a high mortality rate and are more likely to die in the ICU if their admission diagnosis is peritonitis and hepatorenal syndrome.  Poor prognostic markers for cirrhosis patients admitted to the ICU are elevated bilirubin, high lactate, increased INR, and increased need for blood transfusions.
 


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