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Critical Care |

Impact of Liver Cirrhosis on Outcomes in Patients With Sepsis/Septic Shock

Arun Sharma*, MD; Sachin Mohan, MD; Christa Schorr, MSN; Karen Vito, BSN; Barry Milcarek, PhD; Krystal Hunter, MBA; Sergio Zanotti, MD
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Cooper University Hospital, Camden, NJ


Chest. 2012;142(4_MeetingAbstracts):410A. doi:10.1378/chest.1388770
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Abstract

SESSION TYPE: Sepsis/Shock Posters

PRESENTED ON: Wednesday, October 24, 2012 at 01:30 PM - 02:30 PM

PURPOSE: Cirrhotic patients are particularly susceptible to bacterial infections due to increased bacterial translocation, possibly related to liver dysfunction and reduced reticulo-endothelial function. Looking retrospectively, we wished to evaluate population of patients with pre-existing liver cirrhosis and determine the outcomes with severe sepsis/septic shock.

METHODS: We utilized the Project Impact database 2002-2010 and evaluated two categories of patients with cirrhosis and without cirrhosis of liver, admitted with a diagnosis of sepsis/septic shock. Various parameters including ICU length-of-stay (LOS), ICU diagnoses, duration of mechanical ventilation, in-patient mortality, and in-hospital LOS were reviewed. Using a multivariate regression analysis, we tried to decipher the true independence of the association between liver cirrhosis and outcome/mortality.

RESULTS: A sample of 1351 patients was studied and 55 of them had pre-existing liver cirrhosis. The median ICU length-of-stay for cirrhotics vs non-cirrhotics was 3.73 days (confidence interval 0.77-10.8) vs 4.04(confidence interval 1.92-9.5); P=0.890 using Mann Whitney U test. The cirrhotic patient was more likely to be a male; 67.3 vs 51.4 in the non cirrhosis (P <0.021 using Pearson Chi square) and have a higher average number of ICU diagnoses; 6.62 vs 5.78 (P <0.014 using Independent T test), also had higher number of days on vasopressors; 5 vs 4 median days (P<0.013 using Mann Whitney U test). At 30 days, the hospital mortality rate was 63.6 % in the cirrhosis group and 37.8 % in the non cirrhosis group (P <0.001 using Pearson Chi square).

CONCLUSIONS: Cirrhosis was associated with significantly increased 30 day mortality rate (2.807 times more than non cirrhotic sample) among patients sample studied with sepsis/sever sepsis and septic shock (Multivariate regression analysis, 95 % confidence interval, 1.446 to 5.450).

CLINICAL IMPLICATIONS: With this retrospective analysis, it seems that pre existing liver cirrhosis is an independent factor contributing to significant mortality in patients with severe sepsis/septic shock. Further prospective studies in this group of population would help confirm the findings of this study.

DISCLOSURE: The following authors have nothing to disclose: Arun Sharma, Sachin Mohan, Christa Schorr, Karen Vito, Barry Milcarek, Krystal Hunter, Sergio Zanotti

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Cooper University Hospital, Camden, NJ

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