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BJA Advance Access published online on July 18, 2006
British Journal of Anaesthesia, doi:10.1093/bja/ael177
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© The Board of Management and Trustees of the British Journal of Anaesthesia 2006. All rights reserved. For Permissions, please e-mail: journals.permissions@oxfordjournals.org
Accepted May 31, 2006

Clinical Investigation

One year outcome of intensive care patients with decompensated alcoholic liver disease

I. J. Mackle 1, D. G. Swann 1, and B. Cook 1 *

1 Department of Anaesthesia, Critical Care and Pain Management, The Royal Infirmary of Edinburgh at Little France, 51 Little France Crescent, Old Dalkeith Road, Edinburgh EH16 4SA, UK

* To whom correspondence should be addressed.
B. Cook, E-mail: brian.cook{at}luht.scot.nhs.uk


  Abstract

Background. We aimed to examine the outcome of patients with decompensated alcoholic liver disease (ALD) admitted to a general intensive care unit (ICU).

Methods. Retrospective observational cohort study of intensive care admissions over a 3 yr period was conducted. The study was set in an ICU in a UK university hospital with a tertiary liver referral unit. One hundred and ten admissions, involving 107 patients, with decompensated ALD were included. Intensive care, hospital, and 6 and 12 months mortality were recorded along with the outcome in diagnostic and organ system support subgroups. Intensive care, hospital, 6 month and 12 month mortality rates were 58, 71, 78 and 81%.

Results. Hospital mortality in the sepsis/multiorgan failure group was 88%. Sixty-nine per cent of patients who were ventilated but required no other organ support survived to hospital discharge. However, the requirement for any other organ support, or a raised creatinine (>120 µmol litre-1) in the first 24 h, reduced the hospital survival to <15%. In those patients requiring acute renal replacement therapy, the hospital mortality was 94%.

Conclusion. Decompensated ALD requiring intensive care admission is associated with a high hospital mortality and consideration should be given to the futility of escalating organ support measures, particularly when renal replacement therapy is required.

Keywords: complications, alcohol liver disease; critical care, outcome; liver, failure.
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