Renal and brain failure predict mortality of patients with acute-on-chronic liver failure admitted to the intensive care unit
Por:
Mendez-Guerrero, Osvely, Calle-Rodas, Daniel A., Cervantes-Alvarez, Eduardo, Alatorre-Arenas, Elisa, Perez-Escobar, Juanita, Navarro-Alvarez, Nalu, Torre, Aldo
Publicada:
1 may 2021
Ahead of Print:
1 ene 2020
Resumen:
Introduction and Objectives: Acute on Chronic Liver Failure (ACLF) is
characterized by organ failure and high 28-day mortality. Identifying
clinical predictors associated with early mortality could have
implications for the treatment of patients with ACLF.
Patients and methods: Patients diagnosed with chronic liver failure that
developed ACLF based on the EASLCLIF Consortium definition admitted to
the Intensive care unit of a tertiary hospital between 2012 &
ndash;2018 were included. Bivariate and multivariate Cox regression
analyses were performed to identify factors associated with mortality.
Results: 148 patients (55% female) were diagnosed with ACLF of which
55% (n = 82) had ACLF grade 3, 28% (n = 41) grade 2 and 17% (n = 25)
grade 1. The median age was 54 years (41-63). Hepatitis C virus (HCV)
was the most frequent etiology in 29.8% (n = 44) of the patients with
bacterial infection being the most predominant precipitant factor in
58.1% (n = 86). Ninety-day global cumulative survival was only 18%.
When divided by grade, mortality reached to 10% in ACLF 3. Moreover, in
the multivariate Cox regression analysis, renal failure (HR 3.26, 95%
CI (2.13 & ndash;4.99), brain failure (HR 1.37, 95% CI 1.09 &
ndash;2.04) and male sex (HR 1.62, 95% CI 1.10 & ndash;2.40) were
independent predictors of 28-and 90-day mortality.
Conclusions: ACLF is a frequent syndrome among chronic liver disease
patients. Brain and renal failure are significantly associated with
higher mortality and are independent predictors of 28 and 90-day
mortality.
(c) 2020 Fundaci & oacute;n Cli & acute;nica M & eacute;dica Sur,
A.C. Published by Elsevier Espana, S.L.U. This is an open access article
under the CC BY-NC-ND license
(http://creativecommons.org/licenses/by-nc-nd/4.0/).
Filiaciones:
Mendez-Guerrero, Osvely:
Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Department of Gastroenterology, Mexico City, Mexico
Calle-Rodas, Daniel A.:
Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Department of Gastroenterology, Mexico City, Mexico
Cervantes-Alvarez, Eduardo:
Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Department of Gastroenterology, Mexico City, Mexico
PECEM, Facultad de Medicina, Universidad Nacional Autónoma de México, Mexico City, Mexico
Alatorre-Arenas, Elisa:
Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Department of Gastroenterology, Mexico City, Mexico
Perez-Escobar, Juanita:
Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Department of Gastroenterology, Mexico City, Mexico
Navarro-Alvarez, Nalu:
Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Department of Gastroenterology, Mexico City, Mexico
Universidad Panamericana School of Medicine, Campus México, Mexico City, Mexico
Department of Surgery, University of Colorado Anschutz Medical Campus, Denver, CO, United States
Torre, Aldo:
Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Department of Gastroenterology, Mexico City, Mexico
Hybrid Gold, Gold
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