Risk Factors and Outcomes of Acute Respiratory Distress Syndrome in Critically Ill Patients with Cirrhosis. Journal Article


Authors: Yang, P; Formanek, P; Scaglione, S; Afshar, M
Article Title: Risk Factors and Outcomes of Acute Respiratory Distress Syndrome in Critically Ill Patients with Cirrhosis.
Abstract: AIM: Prior randomized controlled trials of acute respiratory distress syndrome (ARDS) excluded critically ill patients with cirrhosis. Data regarding risk factors for ARDS development and outcomes from ARDS in patients with cirrhosis are scarce. We sought to characterize outcomes from ARDS in patients with cirrhosis. METHODS: An observational cohort of patients with cirrhosis admitted to an intensive care unit (ICU) at a high-volume liver transplant center between January 1, 2012 and December 31, 2014 were reviewed. ARDS cases were identified according to the Berlin definition. Potential risk factors were examined in multivariable logistic regression analysis for ARDS development. Outcomes including in-hospital mortality were compared between ARDS and non-ARDS patients. RESULTS: 559 patients met inclusion criteria and 45 (8.1%) developed ARDS. Differences between ARDS and non-ARDS patients included sepsis, Model for End-Stage Liver Disease - Sodium score, and Sequential Organ Failure Assessment score. In-hospital mortality was higher in cirrhotic patients with ARDS compared to those without ARDS (82.2% vs. 27.6%, p0.001). In multivariable analysis, acute on chronic liver failure (ACLF) (OR 8.69, 95% CI 2.28-33.18, p0.01) and shock on ICU admission (OR 3.13, 95% CI 1.57-6.24, p=0.001) were associated with ARDS development, whereas etiology of cirrhosis or alcohol use were not. CONCLUSIONS: ACLF and shock on ICU admission were risk factors for ARDS development, whereas etiology of cirrhosis and alcohol were not. Mortality from ARDS was markedly increased in patients with cirrhosis. Early recognition and treatment for infection may be important for improving the high mortality in this group of patients.
Journal Title: Hepatology research : the official journal of the Japan Society of Hepatology
Publisher: Unknown  
Date Published: 2018