Cirrhotic Patients on Mechanical Ventilation Have a Low Rate of Successful Extubation and Survival
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ORIGINAL ARTICLE
Cirrhotic Patients on Mechanical Ventilation Have a Low Rate of Successful Extubation and Survival Roula Sasso1 · Steven Lauzon2 · Don C. Rockey1 Received: 3 May 2019 / Accepted: 6 January 2020 © Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Background and Aims We hypothesized that mechanically ventilated cirrhotic patients not only have poor outcomes, but also that certain clinical variables are likely to be associated with mortality. We aimed to describe the predictors of mortality in these patients. Methods This observational study examined 113 mechanically ventilated cirrhotic patients cared for at our institution between July 1, 2014, and February 28, 2018. We performed bivariate and multivariate analyses to identify risk factors for mortality on mechanical ventilation and created an equation to calculate probability of mortality based on these variables. Results Seventy percent of patients had a history of a decompensating event. Altered mental status was the most frequently encountered indication for intubation (46%). 53% patients died on mechanical ventilation. After controlling for variables associated with increased mortality, multivariate analysis revealed that vasopressor use was the strongest predictor of mortality on mechanical ventilation (OR = 9.3) followed by sepsis (OR = 4.1). A formula with an area under the curve of 0.85 was obtained in order to predict the probability of mortality for cirrhotic patients on mechanical ventilation (available at https ://medweb.musc.edu/mvcp/). This model (AUC = 0.85) outperformed the CLIF-SOFA score (AUC = 0.68) in predicting mortality in this cohort. Conclusion Cirrhotic patients requiring mechanical ventilation have an extremely poor prognosis, and in patients requiring vasopressors, having a history of decompensation, sepsis or low albumin, mortality is higher. Our data points to the clinical variables should be considered in the medical management of these patients and provide physicians with a formula to predict the probability of mortality. Keywords Death · Hepatic decompensation · Vasopressors · Critical care · Intensive care · Intubation
Introduction Cirrhotic patients are frequently admitted to the hospital with episodes of decompensation and often require intensive care management as a result. These patients regularly need escalation of medical care and frequently require vasopressors, Electronic supplementary material The online version of this article (https://doi.org/10.1007/s10620-020-06051-6) contains supplementary material, which is available to authorized users. * Don C. Rockey [email protected] 1
Department of Medicine, Medical University of South Carolina, 96 Jonathan Lucas Street, CSB, Room 803, Charleston, SC 29425, USA
Department of Public Health Sciences, Medical University of South Carolina, Charleston, USA
2
renal replacement therapy and mechanical ventilation. Complications and decompensation events in cirrhotic patients are often accompanied by progressive organ failu
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