[Mortality and prognostic factors of the cirrhotic patients with hepatic encephalopathy admitted to medical intensive care unit]. / Mortalité et facteurs pronostiques des patients cirrhotiques en encéphalopathie hépatique admis en réanimation.
Ann Fr Anesth Reanim
; 26(6): 490-5, 2007 Jun.
Article
em Fr
| MEDLINE
| ID: mdl-17521851
ABSTRACT
OBJECTIVE:
To assess mortality and to identify variables that could predict it in cirrhotic patients hospitalized to the medical intensive care unit (MICU) for hepatic encephalopathy (HE). STUDYDESIGN:
Retrospective cohort study. PATIENTS ANDMETHODS:
From January 1995 to December 2004, the cirrhotic patients admitted consecutively in MICU were screened and those with altered level of consciousness were included. The MICU mortality rate was assessed. Nearly 80 variables were analyzed and compared between survivors and non-survivors. STATISTICALANALYSIS:
t test, chi(2) or Fisher exact tests, Kaplan-Meier and log rank, Cox regression analysis.RESULTS:
A total of 180 patients (42 women-138 men, mean age 59+/-10 years) were admitted (incidence 2.6%). The SAPS II was 30.1+/-11, Acute Physiology Age and Chronic Health Evaluation II (APACHE II) 16.5+/-5.3, Child-Pugh score 9.1+/-1.9 and GCS 11+/-2.8. The causes of liver cirrhosis was identified in 41.2% of cases (viral 35.6%, alcohol 5.6%). Nearly 18% of patients had an antecedent of HE. The causes of HE were infection (65.6%), upper gastrointestinal bleeding (32.2%), drugs (5%) and metabolic cause (5%). MICU mortality rate was 33.3% and seemed higher in gastrointestinal bleeding. Eighteen variables were significantly associated with poor prognosis in univariate analysis. Only three variables remained significant in multivariateanalysis:
systolic blood pressure<90 mmHg (RR=4; IC 95%=2-8.1), total WBC>12000 n/mm(3) (RR=3.1; IC 95%=1.8-5.3) and use of mechanical ventilation (RR=3.1; IC 95%=1.7-5.6).CONCLUSION:
The MICU mortality of cirrhotic patients with HE was high and significantly associated with haemodynamic instability, hyperleucocytosis and mechanical ventilation.
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Base de dados:
MEDLINE
Assunto principal:
Encefalopatia Hepática
/
Cirrose Hepática
Tipo de estudo:
Etiology_studies
/
Incidence_studies
/
Observational_studies
/
Prognostic_studies
/
Risk_factors_studies
Limite:
Aged
/
Female
/
Humans
/
Male
/
Middle aged
Idioma:
Fr
Ano de publicação:
2007
Tipo de documento:
Article