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Prevalence and outcome of cirrhosis patients admitted to UK intensive care: a comparison against dialysis-dependent chronic renal failure patients

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Abstract

Purpose

Patients with decompensated liver cirrhosis who are admitted to intensive care units (ICU) are perceived, within the UK, as having a particularly poor prognosis.

Methods

We performed a descriptive analysis of cirrhosis patients admitted to general critical care units 1995–2008 compared to patients admitted with pre-existing chronic renal failure. Data were obtained from the Intensive Care National Audit and Research Centre Case Mix Programme Database incorporating 192 adult critical care units in England, Wales and Northern Ireland.

Results

Cirrhosis accounted for 2.6 % (16,096 patients) of total admissions with mean age 52.5 years and male preponderance (~60 %). Hospital mortality was high (>55 %) although this improved 5 % in recent years, and median length of stay was short (2.5 days). Mortality in cirrhotics with severe sepsis requiring organ support was 65–90 %, compared to 33–39 % in those without. Conversely, patients with chronic renal failure had lower mortality (42 %) despite similar characteristics and higher acute physiology and chronic health evaluation (APACHE) II scores. The APACHE II score under-predicted mortality in cirrhotics.

Conclusions

Cirrhosis patients exhibit worse outcomes compared to pre-existing renal failure patients, despite similar characteristics. Survival worsens considerably with organ failure, especially with sepsis. They represent a small number of admissions, albeit increasing over recent years, and, in general, have a short ICU stay. Patients with single organ failure have acceptable survival rates and mortality has improved; although we have no data on those refused ICU admission potentially causing survival bias. Given the extremely high mortality in patients with multi-organ failure, support should be limited/withdrawn in such patients.

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Abbreviations

APACHE:

Acute physiology and chronic health evaluation

CCMDS:

Critical care minimum data set

CMPD:

Case mix programme database

CRF:

Chronic renal failure patients requiring renal replacement therapy prior to ICU admission

ICNARC:

Intensive Care National Audit and Research Centre

ICU:

Intensive care unit

PMH:

Past medical history

RRT:

Renal replacement therapy

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Acknowledgments

The authors would like to thank all the intensive care units contributing data to the CMPD. This study was supported by the Intensive Care National Audit and Research Centre (ICNARC), a Registered Charity (no. 1039417) and Registered Company limited by guarantee (no. 2946727). AOB and MS work at UCLH/UCL, which receives a proportion of funding from the Department of Health’s NIHR Biomedical Research Centre’s funding scheme.

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None.

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Authors and Affiliations

  1. Department of Clinical Pharmacology, University College London, 5 University Street, London, WC1E 6JF, UK

    Alastair J. O’Brien

  2. Department of Medicine, University College London, London, UK

    Alastair J. O’Brien & Mervyn Singer

  3. Intensive Care National Audit and Research Centre, Tavistock House, Tavistock Square, London, WC1H 9HR, UK

    Cathy A. Welch & David A. Harrison

Authors
  1. Alastair J. O’Brien
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  2. Cathy A. Welch
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  3. Mervyn Singer
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  4. David A. Harrison
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Correspondence to Alastair J. O’Brien.

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O’Brien, A.J., Welch, C.A., Singer, M. et al. Prevalence and outcome of cirrhosis patients admitted to UK intensive care: a comparison against dialysis-dependent chronic renal failure patients. Intensive Care Med 38, 991–1000 (2012). https://doi.org/10.1007/s00134-012-2523-2

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  • DOI: https://doi.org/10.1007/s00134-012-2523-2

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