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Acute-on-Chronic Liver Failure Syndrome - Clinical Results from an Intensive Care Unit in a Liver Transplant Center

2020-03Journal article Open access
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dc.contributor.authorPereira, R
dc.contributor.authorBagulho, L
dc.contributor.authorSousa Cardoso, F
dc.date.accessioned2021-07-16T13:26:38Z
dc.date.available2021-07-16T13:26:38Z
dc.date.issued2020-03
dc.description.abstractObjective: To characterize a cohort of acute-on-chronic liver failure patients in Intensive Care and to analyze the all-cause 28-day mortality risk factors assessed at ICU admission and day 3. Methods: This was a retrospective cohort study of consecutive patients admitted to the intensive care unit between March 2013 and December 2016. Results: Seventy-one patients were included. The median age was 59 (51 - 64) years, and 81.7% of patients were male. Alcohol consumption alone (53.5%) was the most frequent etiology of cirrhosis and infection (53.5%) was the most common acute-on-chronic liver failure precipitating event. At intensive care unit admission, the clinical severity scores were APACHE II 21 (16 - 23), CLIF-SOFA 13 (11 - 15), Child-Pugh 12 (10 - 13) and MELD 27 (20 - 32). The acute-on-chronic liver failure scores were no-acute-on-chronic liver failure: 11.3%; one: 14.1%; two: 28.2% and three: 46.5%; and the number of organ failures was one: 4.2%; two: 42.3%; three: 32.4%; four: 16.9%; and five: 4.2%. Liver transplantation was performed in 15.5% of patients. The twenty-eight-day mortality rate was 56.3%, and the in-ICU mortality rate was 49.3%. Organ failure at intensive care unit admission (p = 0.02; OR 2.1; 95%CI 1.2 - 3.9), lactate concentration on day 3 (p = 0.02; OR 6.3; 95%CI 1.4 - 28.6) and the international normalized ratio on day 3 (p = 0.03; OR 10.2; 95%CI 1.3 - 82.8) were independent risk factors. Conclusion: Acute-on-chronic liver failure patients presented with high clinical severity and mortality rates. The number of organ failures at intensive care unit admission and the lactate and international normalized ratio on day 3 were independent risk factors for 28-day mortality. We consider intensive care essential for acute-on-chronic liver failure patients and timely liver transplant was vital for selected patients.pt_PT
dc.description.versioninfo:eu-repo/semantics/publishedVersionpt_PT
dc.identifier.citationRev Bras Ter Intensiva. 2020 Mar;32(1):49-57.pt_PT
dc.identifier.doi10.5935/0103-507x.20200009pt_PT
dc.identifier.urihttp://hdl.handle.net/10400.17/3773
dc.language.isoengpt_PT
dc.peerreviewedyespt_PT
dc.publisherScielopt_PT
dc.subjectAcute-On-Chronic Liver Failurept_PT
dc.subjectCause of Deathpt_PT
dc.subjectCohort Studiespt_PT
dc.subjectFemalept_PT
dc.subjectHumanspt_PT
dc.subjectIntensive Care Unitspt_PT
dc.subjectMalept_PT
dc.subjectMiddle Agedpt_PT
dc.subjectRetrospective Studiespt_PT
dc.subjectRisk Factorspt_PT
dc.subjectLiver Transplantationpt_PT
dc.subjectHCC UCIpt_PT
dc.subjectCHLC CHBPTpt_PT
dc.titleAcute-on-Chronic Liver Failure Syndrome - Clinical Results from an Intensive Care Unit in a Liver Transplant Centerpt_PT
dc.title.alternativeSíndrome da Doença Hepática Crónica Agudizada - Resultados Clínicos de uma Unidade de Terapia Intensiva em Centro de Transplante Hepáticopt_PT
dc.typejournal article
dspace.entity.typePublication
oaire.citation.endPage57pt_PT
oaire.citation.issue1pt_PT
oaire.citation.startPage49pt_PT
oaire.citation.titleRevista Brasileira de Terapia Intensivapt_PT
oaire.citation.volume32pt_PT
rcaap.rightsopenAccesspt_PT
rcaap.typearticlept_PT

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