Factors That Predict Short-term Intensive Care Unit Mortality in Patients With Cirrhosis

Ranjeeta Bahirwani, Marwan Ghabril, Kimberly A. Forde, Hemant Chatrath, Karen M. Wolf, Lindsay Uribe, K. Rajender Reddy, Barry Fuchs, Naga Chalasani

Research output: Contribution to journalArticle

12 Citations (Scopus)

Abstract

Background & Aims: Despite advances in critical care medicine, the mortality rate is high among critically ill patients with cirrhosis. We aimed to identify factors that predict early (7 d) mortality among patients with cirrhosis admitted to the intensive care unit (ICU) and to develop a risk-stratification model. Methods: We collected data from patients with cirrhosis admitted to the ICU at Indiana University (IU-ICU) from December 1, 2006, through December 31, 2009 (n = 185), or at the University of Pennsylvania (Penn-ICU) from May 1, 2005, through December 31, 2010 (n = 206). Factors associated with mortality within 7 days of admission (7-d mortality) were determined by logistic regression analyses. A model was constructed based on the predictive parameters available on the first day of ICU admission in the IU-ICU cohort and then validated in the Penn-ICU cohort. Results: Median Model for End-stage Liver Disease (MELD) scores at ICU admission were 25 in the IU-ICU cohort (interquartile range, 23-34) and 32 in the Penn-ICU cohort (interquartile range, 26-41); corresponding 7-day mortalities were 28.3% and 53.6%, respectively. MELD score (odds ratio, 1.13; 95% confidence interval [CI], 1.07-1.2) and mechanical ventilation (odds ratio, 5.7; 95% CI, 2.3-14.1) were associated independently with 7-day mortality in the IU-ICU. A model based on these 2 variables separated IU-ICU patients into low-, medium-, and high-risk groups; these groups had 7-day mortalities of 9%, 27%, and 74%, respectively (concordance index, 0.80; 95% CI, 0.72-0.87; P <10-8). The model was applied to the Penn-ICU cohort; the low-, medium-, and high-risk groups had 7-day mortalities of 33%, 56%, and 71%, respectively (concordance index, 0.67; 95% CI, 0.59-0.74; P <10-4). Conclusions: A model based on MELD score and mechanical ventilation on day 1 can stratify risk of early mortality in patients with cirrhosis admitted to the ICU. More studies are needed to validate this model and to enhance its clinical utility.

Original languageEnglish (US)
Pages (from-to)1194-1200
Number of pages7
JournalClinical Gastroenterology and Hepatology
Volume11
Issue number9
DOIs
StatePublished - Sep 2013
Externally publishedYes

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Intensive Care Units
Fibrosis
Mortality
End Stage Liver Disease
Confidence Intervals
Artificial Respiration
Odds Ratio
Critical Care
Critical Illness
Logistic Models
Regression Analysis
Medicine

Keywords

  • Cirrhosis
  • Intensive Care
  • MELD
  • Mortality
  • Predictors

ASJC Scopus subject areas

  • Gastroenterology
  • Hepatology

Cite this

Factors That Predict Short-term Intensive Care Unit Mortality in Patients With Cirrhosis. / Bahirwani, Ranjeeta; Ghabril, Marwan; Forde, Kimberly A.; Chatrath, Hemant; Wolf, Karen M.; Uribe, Lindsay; Reddy, K. Rajender; Fuchs, Barry; Chalasani, Naga.

In: Clinical Gastroenterology and Hepatology, Vol. 11, No. 9, 09.2013, p. 1194-1200.

Research output: Contribution to journalArticle

Bahirwani, Ranjeeta ; Ghabril, Marwan ; Forde, Kimberly A. ; Chatrath, Hemant ; Wolf, Karen M. ; Uribe, Lindsay ; Reddy, K. Rajender ; Fuchs, Barry ; Chalasani, Naga. / Factors That Predict Short-term Intensive Care Unit Mortality in Patients With Cirrhosis. In: Clinical Gastroenterology and Hepatology. 2013 ; Vol. 11, No. 9. pp. 1194-1200.
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AU - Forde, Kimberly A.

AU - Chatrath, Hemant

AU - Wolf, Karen M.

AU - Uribe, Lindsay

AU - Reddy, K. Rajender

AU - Fuchs, Barry

AU - Chalasani, Naga

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N2 - Background & Aims: Despite advances in critical care medicine, the mortality rate is high among critically ill patients with cirrhosis. We aimed to identify factors that predict early (7 d) mortality among patients with cirrhosis admitted to the intensive care unit (ICU) and to develop a risk-stratification model. Methods: We collected data from patients with cirrhosis admitted to the ICU at Indiana University (IU-ICU) from December 1, 2006, through December 31, 2009 (n = 185), or at the University of Pennsylvania (Penn-ICU) from May 1, 2005, through December 31, 2010 (n = 206). Factors associated with mortality within 7 days of admission (7-d mortality) were determined by logistic regression analyses. A model was constructed based on the predictive parameters available on the first day of ICU admission in the IU-ICU cohort and then validated in the Penn-ICU cohort. Results: Median Model for End-stage Liver Disease (MELD) scores at ICU admission were 25 in the IU-ICU cohort (interquartile range, 23-34) and 32 in the Penn-ICU cohort (interquartile range, 26-41); corresponding 7-day mortalities were 28.3% and 53.6%, respectively. MELD score (odds ratio, 1.13; 95% confidence interval [CI], 1.07-1.2) and mechanical ventilation (odds ratio, 5.7; 95% CI, 2.3-14.1) were associated independently with 7-day mortality in the IU-ICU. A model based on these 2 variables separated IU-ICU patients into low-, medium-, and high-risk groups; these groups had 7-day mortalities of 9%, 27%, and 74%, respectively (concordance index, 0.80; 95% CI, 0.72-0.87; P <10-8). The model was applied to the Penn-ICU cohort; the low-, medium-, and high-risk groups had 7-day mortalities of 33%, 56%, and 71%, respectively (concordance index, 0.67; 95% CI, 0.59-0.74; P <10-4). Conclusions: A model based on MELD score and mechanical ventilation on day 1 can stratify risk of early mortality in patients with cirrhosis admitted to the ICU. More studies are needed to validate this model and to enhance its clinical utility.

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