A prospective study of 12-month survival of patients with cirrhosis admitted to intensive care.

BACKGROUND: The assessment on whether to escalate care in patients with cirrhosis to the intensive care unit (ICU) is complex, with little data on long-term outcomes. The primary aim of this study was to prospectively examine the ability of liver-specific and ICU prognostic scores to predict 12-month survival among patients with cirrhosis in one non-transplant health service. The secondary aim was to assess the prognostic scores in predicting shorter-term survival and the correlation between other demographic and biochemical factors. METHODS: All patients with cirrhosis who had an unplanned admission to the ICU were included in the study prospectively. Patient demographics and biochemical markers were collected, liver-specific and ICU prognostic scores, as well as the Chronic Liver Failure Consortium acute liver failure and acute decompensation scores were calculated. The pre-acute deterioration Child Turcotte Pugh, Model for End-Stage Liver Disease (MELD) and MELD-Na scores from the 1-6 months prior to the admission were also obtained. RESULTS: One hundred patients were included over 33 months, with a median follow-up of 25 months. Sixty percent of patients survived longer than 12 months. Sepsis was the most common cause of cacute on chronic liver failure; (ACLF), which was associated with a lower 30-day survival. Patients with non-variceal gastrointestinal bleeding were more likely to survive 12 months. In patients with ACLF (n = 57), the day 1 MELD score was the best at predicting long-term survival, whereas in patients without ACLF, none of the scores performed particularly well, with an area under the receiver operating characteristic curve below 0.6. CONCLUSION: Patients with cirrhosis may have excellent long-term outcomes following ICU admissions. Distinguishing whether a patient is in ACLF or non-ACLF may aid with determining the appropriate prognostic score to apply to aid decision making on limitations of patient care.