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Acute-on-chronic liver failure ICU outcomes similar to other patients

Patients with acute-on-chronic liver failure admitted to the ICU had clinical outcomes comparable to patients in the ICU without chronic liver disease and similar baseline severity of illness characteristics, according to a recently published study.

“These findings suggest that ICU care in patients with cirrhosis and organ failure is not universally futile and warrants the same ICU treatment considered in non-cirrhotic patients with end organ failure,” Philippe Meersseman, MD, from the University Hospitals Leuven in Belgium, and colleagues wrote. “In addition, ACLF patients should be evaluated for liver transplantation early on during their ICU stay.”

To compare clinical outcomes among ICU patients with and without ACLF, Meersseman and colleagues analyzed 71 patients admitted to ICU for ACLF and 71 matched patients admitted for sepsis unrelated to ACLF.

Patients with ACLF had higher bilirubin at admission and higher maximum bilirubin during ICU stay compared with the matched group; however, other baseline risk factors such as demographics, comorbidities and illness severity were comparable between the two groups.

Short-term outcomes — such as duration of ICU and hospital stay, development of new ICU-acquired infections, new organ failure, new septic shock, and 90-day mortality — as well as the need for organ support were also similar between patients with ACLF and the matched group.

To exclude the possibility of bias in a comparison between patients with ACLF and patients with sepsis, the researchers also compared the 71 patients with ACLF with another matched group of 71 patients admitted typically for respiratory or gastrointestinal disease. While the patients with ACLF had higher bilirubin at admission and during ICU stay, other baseline risk factors were comparable with the secondary matched group.

“Due to the poor prognosis associated with ACLF and the perception regarding futility of care, the initiation of organ support in the ICU is often questioned by intensive care physicians and hepatologists alike, especially in those patients not eligible for liver transplantation,” the researchers wrote. “However, we now demonstrate that ICU outcome in ACLF patients is similar compared to both septic and medical ICU patients with comparable admission disease severity scores.” – by Talitha Bennett

Disclosure: The authors report no relevant financial disclosures.