Critical Care |

Effect of Infections on Outcomes Among Adult Patients With Acute Liver Failure FREE TO VIEW

Alexander Zider, MD; Radhika Zopey, MD; Ronak Garg, MD; Scott Hu, MD; Tisha Wang, MD; Jane Deng, MD
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University of California - Los Angeles, Los Angeles, CA

Chest. 2013;144(4_MeetingAbstracts):356A. doi:10.1378/chest.1704145
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SESSION TITLE: Critical Care Posters

SESSION TYPE: Original Investigation Poster

PRESENTED ON: Wednesday, October 30, 2013 at 01:30 PM - 02:30 PM

PURPOSE: Patients with liver failure have been shown to have defects in immune function. We hypothesized that patients with acute liver failure who developed infections were at increased risk of adverse outcomes.

METHODS: We conducted a retrospective cohort study on adult patients diagnosed with acute liver failure at a single academic institution between 2005 and 2011. We excluded patients with immunocompromised status (e.g. active malignancy, immunosuppressive medications, etc.), patients with chronic liver disease, and patients who died or were discharged within 48 hours of admission. Approximately 150 patients met our inclusion criteria. Bivariable and multivariable analyses were performed to determine associations with length of stay and in-hospital mortality. Statistical significance was determined by Mann-Whitney and Fisher’s exact test.

RESULTS: Of our entire cohort of patients, approximately 50% were infected on admission or during their hospitalization. The in-hospital mortality rate for all patients was 10%. Almost all of these deaths occurred in the infected group (p=0.04). Length of stay was significantly different between infected patients and non-infected patients (23 days v. 9 days, p<0.001). Of the patients with respiratory failure on admission, approximately 80% either had or developed pneumonia. Pneumonia was the only infection that was significantly associated with mortality (p=0.03). We did not find any significant association between age or MELD score and survival (p = 0.18 and 0.27, respectively). In agreement with prior work, patients meeting King’s college criteria were at increased risk of in-hospital death.

CONCLUSIONS: Our preliminary analysis showed that infections in patients with acute liver failure were associated with in-hospital mortality and length of stay.

CLINICAL IMPLICATIONS: Aggressive measures to prevent pneumonia in acute liver failure patients may improve clinical outcomes. Further research is needed to investigate the mechanisms of immune dysregulation in acute liver failure.

DISCLOSURE: The following authors have nothing to disclose: Alexander Zider, Radhika Zopey, Ronak Garg, Scott Hu, Tisha Wang, Jane Deng

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