Research Article
Outcome of patients with cirrhosis requiring mechanical ventilation in ICU Eric Levesque1,2, Faouzi Saliba2,3,4,⇑, Philippe Ichaï2,3,4, Didier Samuel2,3,4 1
AP-HP Hôpital Henri Mondor, Anesthésie et Réanimations Chirurgicales, Créteil, France; 2AP-HP Hôpital Paul Brousse, Centre Hépato-Biliaire, Villejuif, France; 3Univ Paris-Sud, UMR-S 785, Villejuif, France; 4Inserm, Unité 785, 94800 Villejuif, France
Introduction: Mortality rate of patients with cirrhosis admitted to the intensive care unit (ICU) and requiring mechanical ventilation varies between 60 and 91%. The aim of our study is to assess the prognosis of these patients, their 1-year outcome and to analyze predictive factors of long-term mortality. Methods: From May 2005 to May 2011, we studied 246 consecutive patients with cirrhosis requiring mechanical ventilation either at admission or during their ICU stay. Results: Alcohol was the most common etiology of the cirrhosis (69%). Bleeding related to portal hypertension (30%) and severe sepsis (33%) were the most common reasons for admission. ICU and hospital mortality were respectively 65.9% and 70.3%. Prognostic severity scores, the need for other organ support therapy, infection, and total bilirubin value at ICU admission were significantly associated with ICU mortality. Eighty-four patients (34.1%) were discharged from the ICU. Among these patients, the one-year survival was only of 32%. Logistic regression analysis, using survival at one year as the endpoint, identified two independent risk factors: the length of ventilation (odds ratio [OR] = 1.1; 95% CI, 1.0–1.2; p = 0.02) and total bilirubin at ICU discharge (OR = 1.3; 95% CI, 1.1–1.5; p = 0.006). Conclusion: Patients with cirrhosis admitted to the liver ICU and who required mechanical ventilation have a poor prognosis with a 1-year mortality of 89%. At ICU discharge, a total bilirubin level higher than 64.5 lmol/L and length of ventilation higher than 9 days could help the hepatologists to identify patients at risk of death in the year following the ICU discharge.
Keywords: Cirrhosis; Intensive care unit; Outcome; Mortality; Mechanical ventilation. Received 12 July 2013; received in revised form 25 October 2013; accepted 18 November 2013; available online 23 November 2013 ⇑ Corresponding author. Address: Réanimation, Centre Hépato-Biliaire, Hôpital Paul Brousse, 12 avenue Paul-Vaillant-Couturier, 94804 Villejuif, France. Tel.: +33 1 45 59 64 12; fax: +33 1 45 59 38 57. E-mail address: [email protected] (F. Saliba). Abbreviations: ICU, intensive care unit; OR, odds ratio; SAPS II, simplified acute physiology score; SOFA, sequential organ failure assessment; CLIF-SOFA, chronic liver failure – sequential organ failure assessment; MELD, model for end-stage liver disease; MELD-Na, model for end-stage liver disease with incorporation of serum sodium; CFU, colony forming units; MCPIS, modified clinical pulmonary infection score; ROC, receiver operating characteristic; AUROC, areas under receiver operating characteristic; HIV, human immunodeficiency virus; ACLF, acuteon-chronic liver failure; MARS, molecular adsorbent recirculating system; CRRT, continuous renal replacement therapy; SIRS, systemic inflammatory response syndrome; ECMO, extracorporeal membrane oxygenation.
Ó 2014 Published by Elsevier B.V. on behalf of the European Association for the Study of the Liver.
Introduction The number of patients with liver cirrhosis is increasing and is responsible for approximately 25,000 deaths per year in the United States [1]. It is related to the increase of alcohol related liver disease, of the non-alcoholic fatty liver disease, and of viral hepatitis. In the main situation, this population of patients, with previously compensated cirrhosis, develops acute deterioration revealing their illness. Variceal bleeding, ascites, hepato-renal syndrome, spontaneous bacterial peritonitis and sepsis are the main complications of patients with cirrhosis that would require admission to an Intensive Care Unit (ICU) to optimize management. The outcome of patients with liver cirrhosis in ICU has been widely studied [2–8]. We know that the requirement for ICU admission, whatever the reasons, is associated with high mortality rates ranging from 36% to 86% [2–5]. This mortality is significantly related to the number of organ supports during the ICU stay [6,9–12]. These studies do not specifically address the question of whether there is a difference between patients with respiratory failure and those with other organ failures. In recent studies, mechanical ventilation has been identified as an independent factor related to ICU mortality [6,8]. The decision to intervene aggressively and to use invasive ventilation is frequently questioned in individual patients with cirrhosis. In this subgroup of patients requiring mechanical ventilation, mortality rates reported in the literature range from 59% to 93% [2,13,14]. This high mortality rate exceeds the threshold many physicians would use to withhold ICU care for other diseases [15]. In addition, the need of ventilation is associated with higher costs of stays in patients with cirrhosis admitted in ICU [6]. Thus, such a decision to use mechanical ventilation in patients with cirrhosis must be made bearing in mind both the possibility of cure (by liver transplantation for example) and a not too bad long-term survival of patients discharged from the ICU. To identify patients in whom aggressive treatment may offer recovery or those who may benefit from organ support, i.e., as mechanical ventilation, has always been a challenge for intensivists and hepatologists.
Journal of Hepatology 2014 vol. 60 j 570–578
JOURNAL OF HEPATOLOGY Consecutive cirrhotic patients admitted in intensive care unit (ICU) n = 592
No mechanical ventilation n = 285 (48.1%)
Mechanical ventilation n = 307 (51.9%)
Cirrhotic patients who required mechanical ventilation n = 246
ICU discharge of patients alive n = 84 (34.1%)
One-year transplant free survival n = 17
Liver transplantation n = 10
Patient exclusion, n = 61: • • • •
Mechanical ventilation for elective procedure, n = 47 Re-admission, n = 6 Patients on waiting list for LT before ICU admission, n = 3 Patients who underwent LT during ICU stay, n = 5
Patients who died in ICU n = 162 (65.9%)
Patients who died during the first year after ICU discharge n = 57
Fig. 1. Flow diagram to illustrate the number of patients identified for the study.
The main aim of this prospective study was to evaluate the prognosis of patients with cirrhosis requiring mechanical ventilation during their ICU stay, and to know whether the severity of chronic liver disease or the severity of the acute pulmonary illness or both might determine their outcome.
>92%. Every day, a transient increase in the fraction of inspired oxygen (FiO2) to 100% was carried for assessment of the PaO2/FiO2 ratio. The positive end-expiratory pressure (PEEP) was adjusted to 5 cmH2O at minimum and based to optimize oxygen delivery, without increasing the maximal inspiratory plateau pressure above 28 to 30 cmH2O. The categories of respiratory failure severity were based on hypoxemia severity: mild (200 mmHg 12,000/mm3), elevated C-reactive protein (>50 mg/L), presence of tracheal secretions, a need for increase oxygen supply (FiO2), lung infiltrates or opacities on a chest X-ray. Pneumonia was confirmed by a positive microbial diagnosis (with a threshold of 104 Colony Forming Units/ml (CFU/ml) for bronchoalveolar lavage cultures or 106 CFU/ml in the case of tracheal aspiration [24] or by a modified Clinical Pulmonary Infection Score (mCPIS) calculated retrospectively P5 [25,26].
(15%) were defined as having an ACLF grade 1, 44 (18%) as grade 2, and 127 (52%) as grade 3. The main organ failures were liver failure, cardiovascular failure and respiratory failure (Table 1). One hundred and nineteen patients (48%) required mechanical ventilation at admission. In addition, 127 patients were intubated during their ICU stay. The main reasons for endotracheal intubation and mechanical ventilation were respiratory failure (secondary to infection and shock, n = 148) or airway protection (hepatic encephalopathy, hemorrhage, n = 98). The mean length of mechanical ventilation was 10.9 ± 13.2 days. One hundred and nineteen patients (81%) needed vasopressor therapy (epinephrine, norepinephrine, dobutamine or dopamine >5 lg/kg/min) for septic or hemorrhagic shock. Forty-eight patients required renal replacement therapy (RRT) during their ICU stay. The Molecular Adsorbent Recirculating System (MARSÒ) was used in 31 patients (12.6%) with severe progressive jaundice, hepatic encephalopathy, hepatorenal syndrome or any combination of these syndromes (Table 2). One hundred and eighty five patients (75% of the total study population) had obvious infection as defined in the Patients and methods section. Infection was present in 81 patients at their admission in the liver ICU, mainly related to pneumonia in 35% of cases (n = 30) or spontaneous bacterial peritonitis in 37% of cases (n = 31). One hundred and four patients developed at least one hospital-acquired infection at following sites: respiratory infection (n = 64) with 84% of ventilator–associated pneumonia (n = 54), bacteremia (n = 50), and spontaneous bacterial peritonitis (n = 34).
Statistical analysis Data are expressed as mean ± SD. The Mann-Whitney U test was used to compare continuous variables and Chi-square for categorical variables. Univariate analysis models were used to determine independent, significant, predictive factors of ICU and one-year mortality. To determine independently associated risk factors, a stepwise logistic regression model with ICU mortality and one-year mortality as the dependent variables was applied and odd ratios with 95% confident intervals were determined. All variables were considered for the multivariate logistic regression model if the p value was 32) resistant to corticosteroid therapy. Seven patients were positive for HIV infection. The most common primary diagnosis at ICU admission was severe infection (33%), acute variceal bleeding (30%), or hepatic encephalopathy grade 3/4 (15%). A total of 209 patients (85%) had ACLF (Acute-on-Chronic Liver Failure) at admission to the ICU. Thirty eight patients 572
Outcome and cause of death The median follow-up was 8 months (2–36 months). Follow-up to one year or time of death was completed for the whole cohort. The mean ICU stay and overall hospital stay was 13.3 ± 14.5 days and 20.2 ± 23.3 days, respectively. The cumulative mortality rate was 65.8% (162 of 246 patients) in the liver ICU. Twenty one patients died within the first 24 h following admission to the ICU due to therapy-refractive septic shock or exsanguination. There were no deaths from procedure-related complications of endotracheal intubation or mechanical ventilation. The main cause of death was multiple organ failure secondary to septic or hemorrhagic shock. The development of each new organ failure was significantly associated with the risk of ICU mortality. Fig. 2 shows that ICU mortality were 16% in patients without ACLF at admission and 75% in patients with ACLF (47% for grade 1, 54% for grade 2, 89% for grade 3) as defined by the CLIF-SOFA score. In addition, the number of organ supports (mechanical ventilation, vasopresÒ sor therapy, CRRT and MARS ), during the ICU stay was significantly associated to ICU mortality, which ranged from 6.1% (patients requiring only mechanical ventilation) to 95% (patients requiring the support of three or more organs). Risk factors for ICU mortality The results of the univariate analysis performed on all 246 patients with cirrhosis admitted to the ICU in order to determine predictive factors of ICU mortality are presented in Tables 1 and 2. Age, sex, and etiology of liver disease were not different between survivors and non-survivors. The primary diagnosis at ICU admission did not differ significantly between the patients who died or those who did not. However, in the subgroup of
Journal of Hepatology 2014 vol. 60 j 570–578
JOURNAL OF HEPATOLOGY Table 1. Clinical characteristics of 246 cirrhosis patients admitted to an ICU and needed mechanical ventilation.
Variables Age (years, mean ± SD) Sex (M/F) Length of ICU stay (days, mean ± SD) Length of hospital stay (days, mean ± SD) Cause of cirrhosis, n (%) Alcoholic Viral hepatitis Alcoholic + viral hepatitis Others Primary diagnosis ICU admission, n (%) Acute variceal bleeding Severe infection Hepatic encephalopathy Other Prognostic scores at ICU admission SAPS II SOFA CLIF-SOFA Child-Pugh score Child-Pugh category (A/B/C) MELD MELD-Na Biological parameters at admission Serum sodium (mmol/L) Total bilirubin (µmol/L) Serum creatinine (µmol/L) INR Leucocytes (x103/mm3) Organ failure at admission, n (%)* Liver Lungs Circulation Kidney Cerebral Coagulation
p value
Overall n = 246 56.5 ± 10.3 184/62 13.3 ± 14.5 20.2 ± 23.3
Survivors n = 84 56.3 ± 11.9 62/22 13 ± 10.3 33.2 ± 28.9
Non-survivors n = 162 56.7 ± 9.5 122/40 13.5 ± 16.3 13.5 ± 16.3
170 (69) 46 (19) 14 (6) 16 (6)
50 (59) 23 (27) 3 (4) 8 (9)
120 (74) 23 (14) 11 (7) 8 (5)
74 (30) 81 (33) 38 (15) 53 (22)
28 (33) 19 (23) 23 (27) 14 (17)
46 (29) 62 (38) 15 (9) 39 (24)
61.2 ± 20.1 13.0 ± 4.5 14 ± 4.3 11.5 ± 2.1 5/23/218 28.3 ± 10.7 33.6 ± 14.2
47.6 ± 14.6 9.7 ± 3.1 10.9 ± 3.3 10.5 ± 2 4/13/67 18.8 ± 9.5 22.8 ± 12.7
68.3 ± 18.9 14.7 ± 4.1 15.6 ± 3.5 12.1 ± 1.9 1/10/151 33.2 ± 7.6 39.3 ± 11.3
Outcome of patients with cirrhosis requiring mechanical ventilation in ICU Eric Levesque1,2, Faouzi Saliba2,3,4,⇑, Philippe Ichaï2,3,4, Didier Samuel2,3,4 1
AP-HP Hôpital Henri Mondor, Anesthésie et Réanimations Chirurgicales, Créteil, France; 2AP-HP Hôpital Paul Brousse, Centre Hépato-Biliaire, Villejuif, France; 3Univ Paris-Sud, UMR-S 785, Villejuif, France; 4Inserm, Unité 785, 94800 Villejuif, France
Introduction: Mortality rate of patients with cirrhosis admitted to the intensive care unit (ICU) and requiring mechanical ventilation varies between 60 and 91%. The aim of our study is to assess the prognosis of these patients, their 1-year outcome and to analyze predictive factors of long-term mortality. Methods: From May 2005 to May 2011, we studied 246 consecutive patients with cirrhosis requiring mechanical ventilation either at admission or during their ICU stay. Results: Alcohol was the most common etiology of the cirrhosis (69%). Bleeding related to portal hypertension (30%) and severe sepsis (33%) were the most common reasons for admission. ICU and hospital mortality were respectively 65.9% and 70.3%. Prognostic severity scores, the need for other organ support therapy, infection, and total bilirubin value at ICU admission were significantly associated with ICU mortality. Eighty-four patients (34.1%) were discharged from the ICU. Among these patients, the one-year survival was only of 32%. Logistic regression analysis, using survival at one year as the endpoint, identified two independent risk factors: the length of ventilation (odds ratio [OR] = 1.1; 95% CI, 1.0–1.2; p = 0.02) and total bilirubin at ICU discharge (OR = 1.3; 95% CI, 1.1–1.5; p = 0.006). Conclusion: Patients with cirrhosis admitted to the liver ICU and who required mechanical ventilation have a poor prognosis with a 1-year mortality of 89%. At ICU discharge, a total bilirubin level higher than 64.5 lmol/L and length of ventilation higher than 9 days could help the hepatologists to identify patients at risk of death in the year following the ICU discharge.
Keywords: Cirrhosis; Intensive care unit; Outcome; Mortality; Mechanical ventilation. Received 12 July 2013; received in revised form 25 October 2013; accepted 18 November 2013; available online 23 November 2013 ⇑ Corresponding author. Address: Réanimation, Centre Hépato-Biliaire, Hôpital Paul Brousse, 12 avenue Paul-Vaillant-Couturier, 94804 Villejuif, France. Tel.: +33 1 45 59 64 12; fax: +33 1 45 59 38 57. E-mail address: [email protected] (F. Saliba). Abbreviations: ICU, intensive care unit; OR, odds ratio; SAPS II, simplified acute physiology score; SOFA, sequential organ failure assessment; CLIF-SOFA, chronic liver failure – sequential organ failure assessment; MELD, model for end-stage liver disease; MELD-Na, model for end-stage liver disease with incorporation of serum sodium; CFU, colony forming units; MCPIS, modified clinical pulmonary infection score; ROC, receiver operating characteristic; AUROC, areas under receiver operating characteristic; HIV, human immunodeficiency virus; ACLF, acuteon-chronic liver failure; MARS, molecular adsorbent recirculating system; CRRT, continuous renal replacement therapy; SIRS, systemic inflammatory response syndrome; ECMO, extracorporeal membrane oxygenation.
Ó 2014 Published by Elsevier B.V. on behalf of the European Association for the Study of the Liver.
Introduction The number of patients with liver cirrhosis is increasing and is responsible for approximately 25,000 deaths per year in the United States [1]. It is related to the increase of alcohol related liver disease, of the non-alcoholic fatty liver disease, and of viral hepatitis. In the main situation, this population of patients, with previously compensated cirrhosis, develops acute deterioration revealing their illness. Variceal bleeding, ascites, hepato-renal syndrome, spontaneous bacterial peritonitis and sepsis are the main complications of patients with cirrhosis that would require admission to an Intensive Care Unit (ICU) to optimize management. The outcome of patients with liver cirrhosis in ICU has been widely studied [2–8]. We know that the requirement for ICU admission, whatever the reasons, is associated with high mortality rates ranging from 36% to 86% [2–5]. This mortality is significantly related to the number of organ supports during the ICU stay [6,9–12]. These studies do not specifically address the question of whether there is a difference between patients with respiratory failure and those with other organ failures. In recent studies, mechanical ventilation has been identified as an independent factor related to ICU mortality [6,8]. The decision to intervene aggressively and to use invasive ventilation is frequently questioned in individual patients with cirrhosis. In this subgroup of patients requiring mechanical ventilation, mortality rates reported in the literature range from 59% to 93% [2,13,14]. This high mortality rate exceeds the threshold many physicians would use to withhold ICU care for other diseases [15]. In addition, the need of ventilation is associated with higher costs of stays in patients with cirrhosis admitted in ICU [6]. Thus, such a decision to use mechanical ventilation in patients with cirrhosis must be made bearing in mind both the possibility of cure (by liver transplantation for example) and a not too bad long-term survival of patients discharged from the ICU. To identify patients in whom aggressive treatment may offer recovery or those who may benefit from organ support, i.e., as mechanical ventilation, has always been a challenge for intensivists and hepatologists.
Journal of Hepatology 2014 vol. 60 j 570–578
JOURNAL OF HEPATOLOGY Consecutive cirrhotic patients admitted in intensive care unit (ICU) n = 592
No mechanical ventilation n = 285 (48.1%)
Mechanical ventilation n = 307 (51.9%)
Cirrhotic patients who required mechanical ventilation n = 246
ICU discharge of patients alive n = 84 (34.1%)
One-year transplant free survival n = 17
Liver transplantation n = 10
Patient exclusion, n = 61: • • • •
Mechanical ventilation for elective procedure, n = 47 Re-admission, n = 6 Patients on waiting list for LT before ICU admission, n = 3 Patients who underwent LT during ICU stay, n = 5
Patients who died in ICU n = 162 (65.9%)
Patients who died during the first year after ICU discharge n = 57
Fig. 1. Flow diagram to illustrate the number of patients identified for the study.
The main aim of this prospective study was to evaluate the prognosis of patients with cirrhosis requiring mechanical ventilation during their ICU stay, and to know whether the severity of chronic liver disease or the severity of the acute pulmonary illness or both might determine their outcome.
>92%. Every day, a transient increase in the fraction of inspired oxygen (FiO2) to 100% was carried for assessment of the PaO2/FiO2 ratio. The positive end-expiratory pressure (PEEP) was adjusted to 5 cmH2O at minimum and based to optimize oxygen delivery, without increasing the maximal inspiratory plateau pressure above 28 to 30 cmH2O. The categories of respiratory failure severity were based on hypoxemia severity: mild (200 mmHg 12,000/mm3), elevated C-reactive protein (>50 mg/L), presence of tracheal secretions, a need for increase oxygen supply (FiO2), lung infiltrates or opacities on a chest X-ray. Pneumonia was confirmed by a positive microbial diagnosis (with a threshold of 104 Colony Forming Units/ml (CFU/ml) for bronchoalveolar lavage cultures or 106 CFU/ml in the case of tracheal aspiration [24] or by a modified Clinical Pulmonary Infection Score (mCPIS) calculated retrospectively P5 [25,26].
(15%) were defined as having an ACLF grade 1, 44 (18%) as grade 2, and 127 (52%) as grade 3. The main organ failures were liver failure, cardiovascular failure and respiratory failure (Table 1). One hundred and nineteen patients (48%) required mechanical ventilation at admission. In addition, 127 patients were intubated during their ICU stay. The main reasons for endotracheal intubation and mechanical ventilation were respiratory failure (secondary to infection and shock, n = 148) or airway protection (hepatic encephalopathy, hemorrhage, n = 98). The mean length of mechanical ventilation was 10.9 ± 13.2 days. One hundred and nineteen patients (81%) needed vasopressor therapy (epinephrine, norepinephrine, dobutamine or dopamine >5 lg/kg/min) for septic or hemorrhagic shock. Forty-eight patients required renal replacement therapy (RRT) during their ICU stay. The Molecular Adsorbent Recirculating System (MARSÒ) was used in 31 patients (12.6%) with severe progressive jaundice, hepatic encephalopathy, hepatorenal syndrome or any combination of these syndromes (Table 2). One hundred and eighty five patients (75% of the total study population) had obvious infection as defined in the Patients and methods section. Infection was present in 81 patients at their admission in the liver ICU, mainly related to pneumonia in 35% of cases (n = 30) or spontaneous bacterial peritonitis in 37% of cases (n = 31). One hundred and four patients developed at least one hospital-acquired infection at following sites: respiratory infection (n = 64) with 84% of ventilator–associated pneumonia (n = 54), bacteremia (n = 50), and spontaneous bacterial peritonitis (n = 34).
Statistical analysis Data are expressed as mean ± SD. The Mann-Whitney U test was used to compare continuous variables and Chi-square for categorical variables. Univariate analysis models were used to determine independent, significant, predictive factors of ICU and one-year mortality. To determine independently associated risk factors, a stepwise logistic regression model with ICU mortality and one-year mortality as the dependent variables was applied and odd ratios with 95% confident intervals were determined. All variables were considered for the multivariate logistic regression model if the p value was 32) resistant to corticosteroid therapy. Seven patients were positive for HIV infection. The most common primary diagnosis at ICU admission was severe infection (33%), acute variceal bleeding (30%), or hepatic encephalopathy grade 3/4 (15%). A total of 209 patients (85%) had ACLF (Acute-on-Chronic Liver Failure) at admission to the ICU. Thirty eight patients 572
Outcome and cause of death The median follow-up was 8 months (2–36 months). Follow-up to one year or time of death was completed for the whole cohort. The mean ICU stay and overall hospital stay was 13.3 ± 14.5 days and 20.2 ± 23.3 days, respectively. The cumulative mortality rate was 65.8% (162 of 246 patients) in the liver ICU. Twenty one patients died within the first 24 h following admission to the ICU due to therapy-refractive septic shock or exsanguination. There were no deaths from procedure-related complications of endotracheal intubation or mechanical ventilation. The main cause of death was multiple organ failure secondary to septic or hemorrhagic shock. The development of each new organ failure was significantly associated with the risk of ICU mortality. Fig. 2 shows that ICU mortality were 16% in patients without ACLF at admission and 75% in patients with ACLF (47% for grade 1, 54% for grade 2, 89% for grade 3) as defined by the CLIF-SOFA score. In addition, the number of organ supports (mechanical ventilation, vasopresÒ sor therapy, CRRT and MARS ), during the ICU stay was significantly associated to ICU mortality, which ranged from 6.1% (patients requiring only mechanical ventilation) to 95% (patients requiring the support of three or more organs). Risk factors for ICU mortality The results of the univariate analysis performed on all 246 patients with cirrhosis admitted to the ICU in order to determine predictive factors of ICU mortality are presented in Tables 1 and 2. Age, sex, and etiology of liver disease were not different between survivors and non-survivors. The primary diagnosis at ICU admission did not differ significantly between the patients who died or those who did not. However, in the subgroup of
Journal of Hepatology 2014 vol. 60 j 570–578
JOURNAL OF HEPATOLOGY Table 1. Clinical characteristics of 246 cirrhosis patients admitted to an ICU and needed mechanical ventilation.
Variables Age (years, mean ± SD) Sex (M/F) Length of ICU stay (days, mean ± SD) Length of hospital stay (days, mean ± SD) Cause of cirrhosis, n (%) Alcoholic Viral hepatitis Alcoholic + viral hepatitis Others Primary diagnosis ICU admission, n (%) Acute variceal bleeding Severe infection Hepatic encephalopathy Other Prognostic scores at ICU admission SAPS II SOFA CLIF-SOFA Child-Pugh score Child-Pugh category (A/B/C) MELD MELD-Na Biological parameters at admission Serum sodium (mmol/L) Total bilirubin (µmol/L) Serum creatinine (µmol/L) INR Leucocytes (x103/mm3) Organ failure at admission, n (%)* Liver Lungs Circulation Kidney Cerebral Coagulation
p value
Overall n = 246 56.5 ± 10.3 184/62 13.3 ± 14.5 20.2 ± 23.3
Survivors n = 84 56.3 ± 11.9 62/22 13 ± 10.3 33.2 ± 28.9
Non-survivors n = 162 56.7 ± 9.5 122/40 13.5 ± 16.3 13.5 ± 16.3
170 (69) 46 (19) 14 (6) 16 (6)
50 (59) 23 (27) 3 (4) 8 (9)
120 (74) 23 (14) 11 (7) 8 (5)
74 (30) 81 (33) 38 (15) 53 (22)
28 (33) 19 (23) 23 (27) 14 (17)
46 (29) 62 (38) 15 (9) 39 (24)
61.2 ± 20.1 13.0 ± 4.5 14 ± 4.3 11.5 ± 2.1 5/23/218 28.3 ± 10.7 33.6 ± 14.2
47.6 ± 14.6 9.7 ± 3.1 10.9 ± 3.3 10.5 ± 2 4/13/67 18.8 ± 9.5 22.8 ± 12.7
68.3 ± 18.9 14.7 ± 4.1 15.6 ± 3.5 12.1 ± 1.9 1/10/151 33.2 ± 7.6 39.3 ± 11.3
