Original articlePancreas, biliary tract, and liverIncreased Survival for Patients With Cirrhosis and Organ Failure in Liver Intensive Care and Validation of the Chronic Liver Failure–Sequential Organ Failure Scoring System
Section snippets
Methods
Between January 2000 and December 2010 consecutive admissions to the liver intensive therapy unit (LITU) at King’s College Hospital had prospective predefined capture of baseline demographic and clinical data by dedicated auditors. The worst result/score in the 24-hour period was used for that day's result. These data were collected daily for the total critical care admission period. Detailed LITU discharge documents were produced by senior medical staff and also were used as a data source.
Cohort Characteristics
A total of 1032 patients originally were identified. After exclusions, 971 patients with an underlying diagnosis of cirrhosis were admitted during the period beginning from 2000 to the end of 2011, and formed the basis of the study cohort (Table 1).
The median age was 51 years (range, 16–90 y), with a male:female sex profile of 615:356 (63%:37%). There was no survival difference between men and women and no difference in median admission APACHE II score (P = .548). The median admission MELD
Discussion
We have shown that in more than a decade of experience in treating patients with cirrhosis requiring organ support, clinically meaningful and statistically significant improvements in outcome have occurred. In this cohort even patients with 2 or 3 organs in failure at admission still had 30% to 55% survival rates, although the mortality rate in patients with more than 3 organs in failure at admission approached 80%.
We found that alcohol was not an etiology that was associated with worse
Acknowledgments
All authors are grateful to the National Institute for Health Research biomedical research council at King's College London for infrastructure support during the course of this study. Mark McPhail also thanks the National Institute for Health Research biomedical research center at Imperial College London for infrastructure support during this study.
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Conflicts of interest The authors disclose no conflicts.
Funding Supported by the Wellcome Trust (grant number ME047380MES), United Kingdom, a postdoctoral training fellowship during this study (M.J.W.M.), a doctoral studentship from the National Institute for Health Research (R.D.A.), and by a Higher Education Funding Council for England National Institute for Health Research senior lectureship (D.L.S.).