Prioritization of the cirrhotic patients entering intensive care unit for liver transplantation: Do we need to change the rules?

2013 ◽  
Vol 37 (5) ◽  
pp. 437-438 ◽  
Author(s):  
Yvon Calmus
Keyword(s):  
Intensive Care Unit ◽  
Liver Transplantation ◽  
Intensive Care ◽  
Cirrhotic Patients

The presence of liver cirrhosis is a strong negative predictor of survival for patients admitted to the intensive care unit – Cirrhosis in intensive care patients

2021 ◽  
Author(s):  
Jörg Bojunga ◽  
Mireen Friedrich-Rust ◽  
Alica Kubesch ◽  
Kai Henrik Peiffer ◽  
Hannes Abramowski ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Liver Cirrhosis ◽  
Intensive Care ◽  
Hospital Mortality ◽  
Intensive Care Treatment ◽  
Matched Cohort ◽  
Care Treatment ◽  
Cirrhotic Patients ◽  
The Impact ◽  
Cirrhotic Group

Abstract Background and Aims Liver cirrhosis is a systemic disease that substantially impacts the body’s physiology, especially in advanced stages. Accordingly, the outcome of patients with cirrhosis requiring intensive care treatment is poor. We aimed to analyze the impact of cirrhosis on mortality of intensive care unit (ICU) patients compared to other frequent chronic diseases and conditions. Methods In this retrospective study, patients admitted over three years to the ICU of the Department of Medicine of the University Hospital Frankfurt were included. Patients were matched for age, gender, pre-existing conditions, simplified acute physiology score (SAPS II), and therapeutic intervention scoring system (TISS). Results A total of 567 patients admitted to the ICU were included in the study; 99 (17.5 %) patients had liver cirrhosis. A total of 129 patients were included in the matched cohort for the sensitivity analysis. In-hospital mortality was higher in cirrhotic patients than non-cirrhotic patients (p < 0.0001) in the entire and matched cohort. Liver cirrhosis remained one of the strongest independent predictors of in-hospital mortality (entire cohort p = 0.001; matched cohort p = 0.03) along with dialysis and need for transfusion in the multivariate logistic regression analysis. Furthermore, in the cirrhotic group, the need for kidney replacement therapy (p < 0.001) and blood transfusion (p < 0.001) was significantly higher than in the non-cirrhotic group.  Conclusions In the presented study, liver cirrhosis was one of the strongest predictors of in-hospital mortality in patients needing intensive care treatment along with dialysis and the need for ventilation. Therefore, concerted efforts are needed to improve cirrhotic patients’ outcomes, prevent disease progression, and avoid complications with the need for ICU treatment in the early stages of the disease.

Liver Transplantation for Hemoperitoneum Secondary to Huge Multiple Hemangiomatosis: A Case Report of a Tele-intensive Care Unit in Deceased-Donor Management

2015 ◽  
Vol 21 (6) ◽  
pp. 499-502 ◽  
Author(s):  
Salvatore Gruttadauria ◽  
Duilio Pagano ◽  
Gaetano Burgio ◽  
Antonio Arcadipane ◽  
Giovanna Panarello ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Liver Transplantation ◽  
Intensive Care ◽  
Case Report ◽  
Deceased Donor ◽  
Donor Management

scholarly journals THE COST OF ADULT LIVER TRANSPLANTATION IN A REFERRAL CENTER IN SOUTHERN BRAZIL

2019 ◽  
Vol 56 (2) ◽  
pp. 165-171 ◽  
Author(s):  
Adriane B de SOUZA ◽  
Santiago RODRIGUEZ ◽  
Fábio Luís da MOTTA ◽  
Ajacio B de Mello BRANDÃO ◽  
Claudio Augusto MARRONI
Keyword(s):  
Intensive Care Unit ◽  
Liver Transplantation ◽  
Intensive Care ◽  
Liver Disease ◽  
Southern Brazil ◽  
Referral Center ◽  
End Stage Liver Disease ◽  
End Stage ◽  
The Cost ◽  
Surgical Unit

ABSTRACT BACKGROUND: Liver transplantation (LTx) is the primary and definitive treatment of acute or chronic cases of advanced or end-stage liver disease. Few studies have assessed the actual cost of LTx categorized by hospital unit. OBJECTIVE: To evaluate the cost of LTx categorized by unit specialty within a referral center in southern Brazil. METHODS: We retrospectively reviewed the medical records of 109 patients undergoing LTx between April 2013 and December 2014. Data were collected on demographic characteristics, etiology of liver disease, and severity of liver disease according to the Child-Turcotte-Pugh (CTP) and Model for End-stage Liver Disease (MELD) scores at the time of LTx. The hospital bill was transformed into cost using the full absorption costing method, and the costs were grouped into five categories: Immediate Pretransplant Kit; Specialized Units; Surgical Unit; Intensive Care Unit; and Inpatient Unit. RESULTS: The mean total LTx cost was US$ 17,367. Surgical Unit, Specialized Units, and Intensive Care Unit accounted for 31.9%, 26.4% and 25.3% of the costs, respectively. Multivariate analysis showed that total LTx cost was significantly associated with CTP class C (P=0.001) and occurrence of complications (P=0.002). The following complications contributed to significantly increase the total LTx cost: septic shock (P=0.006), massive blood transfusion (P=0.007), and acute renal failure associated with renal replacement therapy (dialysis) (P=0.005). CONCLUSION: Our results demonstrated that the total cost of LTx is closely related to liver disease severity scores and the development of complications.

scholarly journals Mortality prediction of cirrhotic patients admitted to the Intensive Care Unit

2008 ◽  
Vol 7 (1) ◽  
pp. 78-79 ◽  
Author(s):  
Genaro Vazquez-Elizondo ◽  
Raúl Carrillo-Esper ◽  
Daniel Zamora-Valdés ◽  
Nahum Méndez-Sánchez
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Mortality Prediction ◽  
Cirrhotic Patients

scholarly journals Nutrition Risk Assessment Using the Modified NUTRIC Score in Cirrhotic Patients with Acute Gastroesophageal Variceal Bleeding: Prevalence of High Nutrition Risk and its Independent Prognostic Value

Nutrients ◽  
2019 ◽  
Vol 11 (9) ◽  
pp. 2152 ◽  
Author(s):  
Ming-Hung Tsai ◽  
Hui-Chun Huang ◽  
Yun-Shing Peng ◽  
Yung-Chang Chen ◽  
Ya-Chung Tian ◽  
...  
Keyword(s):  
Risk Assessment ◽  
Intensive Care Unit ◽  
Intensive Care ◽  
Critically Ill ◽  
Variceal Bleeding ◽  
Assessment Tool ◽  
Prognostic Significance ◽  
Adverse Outcomes ◽  
Nutrition Risk ◽  
Cirrhotic Patients

Malnutrition is associated with adverse outcomes in patients with liver cirrhosis. Relevant data about nutrition risk in critically ill cirrhotic patients are lacking. The modified Nutrition Risk in Critically Ill (mNUTRIC) score is a novel nutrition risk assessment tool specific for intensive care unit (ICU) patients. This retrospective study was conducted to evaluate the prevalence and prognostic significance of nutrition risk in cirrhotic patients with acute gastroesophageal variceal bleeding (GEVB) using mNUTRIC scores computed on admission to the intensive care unit. The major outcome was 6-week mortality. One-hundred-and-thirty-one admissions in 120 patients were analyzed. Thirty-eight percent of cirrhotic patients with acute GEVB were categorized as being at high nutrition risk (a mNUTRIC score of ≥5). There was a significantly progressive increase in mortality associated with the mNUTRIC score (χ2 for trend, p < 0.001). By using the area under a receiver operating characteristic (ROC) curve, the mNUTRIC demonstrated good discriminative power to predict 6-week mortality (AUROC 0.859). In multivariate analysis, the mNUTRIC score was an independent factor associated with 6-week mortality. In conclusion, the mNUTRIC score can serve as a tool to assess nutrition risk in cirrhotic patients with acute GEVB.

Sign in / Sign up

Export Citation Format

Share Document