Intensive Care Medicine

, Volume 35, Issue 8, pp 1390–1396

Predictors of bacteraemia and mortality in patients with acute liver failure

  • Constantine J. Karvellas
  • Fred Pink
  • Mark McPhail
  • Timothy Cross
  • Georg Auzinger
  • William Bernal
  • Elizabeth Sizer
  • Demetrios J. Kutsogiannis
  • Ian Eltringham
  • Julia A. Wendon
Original

DOI: 10.1007/s00134-009-1472-x

Cite this article as:
Karvellas, C.J., Pink, F., McPhail, M. et al. Intensive Care Med (2009) 35: 1390. doi:10.1007/s00134-009-1472-x

Abstract

Purpose

To determine what physiological and biochemical factors predict development of bacteraemia and mortality in patients with acute liver failure (ALF).

Methods

Retrospective analysis of 206 ALF patients admitted to a specialist liver intensive therapy unit (LITU) from January 2003 to July 2005 (data collected prospectively).

Results

A total of 206 patients were defined with ALF: 72 (35%) suffered bacteraemia (BAClf) and 134 (65%) did not (NBAClf). Gram positive organisms were observed in 44% of isolates, gram negatives in 52% and fungaemia in 4%. Median time to first bacteraemia was 10 (7–16) days. On admission, BAClf patients had higher SIRS scores and degrees of hepatic encephalopathy (HE). During their LITU course, BAClf patients had significantly increased requirements for renal replacement therapy (RRT), mechanical ventilation, and longer median LITU stay. Multivariate analysis (logistical regression) demonstrated significant predictors of bacteraemia on admission were HE grade >2 (Odds Ratio 1.6) and SIRS score >1 (OR 2.7). In all patients, independent predictors of mortality (logistical) were age (OR 1.41), maximum HE grade pre-intubation (1.76), Lactate (1.14) and Acute Physiology and Chronic Health Evaluation II score (APACHEII) (1.09), but not bacteraemia. Transplantation was protective (OR 0.20).

Conclusion

In this study, severity of hepatic encephalopathy and SIRS score >1 were predictive of bacteraemia. APACHEII was independently predictive of mortality in all ALF patients but not bacteraemia.

Keywords

SepsisSIRSAPACHETransplantationCritical illness

Abbreviations

ALF

Acute liver failure

BAClf

Bacteraemic acute liver failure patients

95% CI

95% confidence interval

HE

Hepatic encephalopathy

HR

Heart rate

ICU

Intensive care unit

LITU

Liver Intensive therapy (care) unit

LT

Liver transplantation

MAP

Mean arterial pressure

MV

Mechanical ventilation

NBAClf

Non-bacteraemic acute liver failure

NINSS

Nosocomial infection national surveillance scheme

OR

Odds ratio

RRT

Renal replacement therapy

SIRS

Systemic inflammatory response syndrome

TA

Tracheal aspirates

VAP

Ventilator-associated pneumonia

Copyright information

© Springer-Verlag 2009

Authors and Affiliations

  • Constantine J. Karvellas
    • 1
    • 2
  • Fred Pink
    • 2
  • Mark McPhail
    • 2
  • Timothy Cross
    • 2
  • Georg Auzinger
    • 2
  • William Bernal
    • 2
  • Elizabeth Sizer
    • 2
  • Demetrios J. Kutsogiannis
    • 1
  • Ian Eltringham
    • 2
  • Julia A. Wendon
    • 2
  1. 1.Division of Critical Care MedicineUniversity of AlbertaEdmontonCanada
  2. 2.Institute of Liver StudiesKing’s College HospitalLondonUK