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Clinical Predictors of Intensive Care Unit Transfer in Admitted Patients with Cirrhosis
Journal article   Open access   Peer reviewed

Clinical Predictors of Intensive Care Unit Transfer in Admitted Patients with Cirrhosis

Matthew Dukewich, Chung-Heng Liu, Ethan M Weinberg, Nadim Mahmud and K Rajender Reddy
Digestive diseases and sciences, v 68(6), pp 2344-2359
Jun 2023
DOI: https://doi.org/10.1007/s10620-023-07856-x
PMID: 36781572
Featured in Collection :   UN Sustainable Development Goals @ Drexel
url
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10192086View
Accepted (AM) Open PubMed Central

Abstract

Hospital Mortality Humans Hyponatremia - complications Intensive Care Units Liver Cirrhosis - complications Liver Cirrhosis - diagnosis Liver Cirrhosis - therapy Prognosis Retrospective Studies
Patients with cirrhosis are at high risk of mortality after organ failure that requires ICU care. There have been attempts to predict which patients are at highest risk, with some success found in adapting liver disease-specific scoring systems with clinical variables commonly associated with critical illness. However, the clinical factors predictive of which patients with cirrhosis are most at-risk of needing ICU level care are unknown. Our study set out to better understand which clinical variables were associated with need for ICU care in patients with cirrhosis. Retrospective analysis of admitted patients with cirrhosis at single tertiary care center. Patients with cirrhosis admitted to our center were categorized into three groups: those without ICU transfer, those admitted to the ICU directly from the emergency department (ED), and those admitted to the ICU from the medicine floor. These groups differed in mortality at 30 days (3.5% vs. 15% vs. 25%, P < 0.001) and at subsequent intervals up to 1 year. These groups differed in indication for ICU transfer, with GI bleed, hemorrhagic shock, hepatic encephalopathy, and hyponatremia occurring more in the ED-to-ICU group, while respiratory failure was more common in the floor-to-ICU group. In multivariable analysis, factors associated with ICU transfer included worsened kidney function, anemia, hyponatremia, leukocytosis, and the decision to obtain a lactate level. Similar analysis with only floor-to-ICU patients found that ICU transfer was associated with hypoalbuminemia, hyponatremia, hypotension, and SIRS score. Our study found significant differences in mortality among three distinct groups of patients with cirrhosis. A risk factor model for ICU transfer found that variables both specific and nonspecific to liver disease were associated with ICU transfer, with between-group differences supporting the idea of different clinical phenotypes and suggesting factors that should be considered in early triage and assessment of hospitalized patients with cirrhosis.

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4 citations in Web of Science
4 citations in Scopus

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UN Sustainable Development Goals (SDGs)

This publication has contributed to the advancement of the following goals:

#3 Good Health and Well-Being

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Collaboration types
Domestic collaboration
Web of Science research areas
Gastroenterology & Hepatology
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