Alcoholic liver disease in the intensive care unit: Outcomes and predictors of prognosis

Background Hospital admissions with decompensated chronic alcoholic liver disease have been increasing, leading to increased pressure on intensive care unit services. We aimed to determine the outcome and prognostic factors for patients with alcoholic liver disease requiring admission to intensive care unit. Methods This was a retrospective study over 5 years (January 2006–December 2010) of all intensive care unit admissions with alcoholic liver disease to either of the two Leeds Teaching Hospitals NHS Trust general intensive care units. A detailed case note review was conducted based on a pre-established proforma. Eighty-two patients included. Primary outcome was hospital mortality. Results The overall intensive care unit and hospital mortality were 46% and 67%, respectively. Hospital mortality in patients successfully discharged from intensive care unit with the intent of recovery remained high at 21%. Variceal bleed was the only indicator that had a mortality <60%. Factors which suggested a poor outcome included sepsis (86% mortality) and hepato-renal syndrome (86% mortality). A Sequential Organ Failure Assessment score of greater than 10 on intensive care unit admission was associated with 97% hospital mortality. Sequential Organ Failure Assessment score increased from a mean of 10.9–12.5 in those that did not survive hospital. Patients with first alcoholic liver disease related admission had poorer outcomes. Conclusion These results are similar to previous studies with no significant improvement in outcomes. Alcoholic liver disease is not a contra-indication to intensive care unit admission but assessment of the individual patient is required. The most appropriate objective factors to guide prognostication are the presenting intensive care unit diagnosis and Sequential Organ Failure Assessment score. First presentation of alcoholic liver disease is not a positive prognostic indicator.

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Quantification of Thrombelastographic Changes After Blood Component Transfusion in Patients with Liver Disease in the Intensive Care Unit

Anesthesia & Analgesia ◽

10.1213/00000539-199508000-00011 ◽

1995 ◽

Vol 81 (2) ◽

pp. 272-278

Author(s):

Douglas G. Clayton ◽

Adelaida M. Miro ◽

David J. Kramer ◽

Nathaniel Rodman ◽

Stanley Wearden

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Liver Disease ◽

Blood Component ◽

Blood Component Transfusion

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Survival and predictors of outcome among patients with decompensated liver disease in a non‐liver transplant intensive care unit. Pessimism is historical and unjustified

Internal Medicine Journal ◽

10.1111/imj.14151 ◽

2019 ◽

Vol 49 (6) ◽

pp. 745-752

Author(s):

Victoria Sadick ◽

Emma Bowcock ◽

Stuart Lane ◽

Ian Seppelt

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Liver Disease ◽

Liver Transplant ◽

Predictors Of Outcome ◽

Decompensated Liver Disease

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

Arquivos de Gastroenterologia ◽

10.1590/s0004-2803.201900000-33 ◽

2019 ◽

Vol 56 (2) ◽

pp. 165-171 ◽

Cited By ~ 1

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.

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Ondansetron to Treat Pruritus Due to Cholestatic Jaundice

The Journal of Pediatric Pharmacology and Therapeutics ◽

10.5863/1551-6776-18.3.241 ◽

2013 ◽

Vol 18 (3) ◽

pp. 241-346 ◽

Cited By ~ 6

Author(s):

Sarah Dillon ◽

Joseph D. Tobias

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Liver Disease ◽

Treatment Options ◽

Symptomatic Treatment ◽

Cholestatic Jaundice ◽

Cholestatic Liver Disease ◽

Opioid Antagonists

Intractable itching is a symptom of cholestatic liver disease of various causes that is bothersome and difficult to manage. Although treatment of the primary cause of cholestasis is paramount in resolving the issue, given the debilitating consequences of pruritus, symptomatic treatment is frequently necessary. Although many medications including cholestyramine, rifampin, opioid antagonists (i.e., naloxone, naltrexone), phenobarbital, and antihistamines have been used to treat cholestatic-induced pruritus, none has resulted in uniform success. We report anecdotal success with the use of ondansetron to treat pruritus associated with cholestasis following prolonged intensive care unit course of a 16-year-old. The theories accounting for pruritus with cholestasis are presented, treatment options are reviewed, and the role of ondansetron in the treatment of pruritus is discussed.

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Influence of Tigecycline on Liver Function in Adult Patients in the Intensive Care Unit

10.21203/rs.3.rs-773690/v1 ◽

2021 ◽

Author(s):

Jingnan Song ◽

Pan Chen ◽

Zhaoxia Tang ◽

Yifan Zheng ◽

Xiao Chen ◽

...

Keyword(s):

Risk Factors ◽

Intensive Care Unit ◽

Regression Analysis ◽

Intensive Care ◽

Liver Disease ◽

Liver Injury ◽

Liver Function ◽

Adult Patients ◽

Apache Ii Score ◽

Cox Regression Analysis

Abstract Background There are few studies investigating TGC-associated hepatotoxicity in ICU patients, and the pathogenesis of hepatotoxicity and identification of risk factors are limited. Objectives To analyze the influence of tigecycline (TGC) on liver function in adult patients in the Intensive Care Unit to identify potential risk factors for tigecycline-induced liver injury (TILI). Methods Patients receiving tigecycline treatment in ICU during January 2019 to October 2020 were retrospectively enrolled. The liver function parameters before and after tigecycline treatment were collected, and risk factors associated with TILI was identified by logistic regression analysis. The probability of 28-day mortality was determined in Cox regression analysis. Results A total of 242 patients were enrolled, and TILI was identified in 24 patients (9.92%), of whom 75.0% had grade 1 liver injury, and 16.67%, 4.17%, 4.17% had grade 2 to 4 liver injury, respectively. The pattern of hepatotoxicity was hepatocellular in 16 patients (66.67%), cholestatic in 4 patients (16.67%), and mixed in 4 patients (16.67%). The median time from tigecycline start to symptoms was only 5 days (IQR, 3-7 days). Multivariate analysis identified tigecycline dose ≥ 200mg/day, longer course of treatment and preexisting liver disease tend to be independently associated with TILI. In addition, APACHE II score > 15, higher dose of tigecycline and TILI were independent risk factors of 28-day mortality, while longer course of tigecycline reduced this risk despite its association with TILI. Conclusions The maintenance dose and course of tigecycline, as well as liver disease is considered as risk factors of hepatotoxicity. 28-day mortality tended to be higher in TILI patients. The relationships among tigecycline dose and course, TILI and mortality should be further investigated.

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