Only one recent study has reported the median survival (0.19 years) and life expectancy (3.59 years) of 1478 LC patients requiring PMV 11.
However, investigations focusing on the prognoses and outcomes of patients with LC requiring PMV are scarce. Once the outcome can be fully understood and the prognosis can be accurately predicted, physicians can help patients and their families make the best choice regarding the use of PMV. Being able to predict whether an LC patient will need PMV and be able to predict their outcomes would allow for healthy mutual communication between physicians, patients, and their family to arrive at a consensus about their post-PMV care plans. Such patients require a lot of healthcare resources and medical expenses however, their prognoses are unclear and difficult to assess. Although the mortality rate of critically ill patients with LC who need MV is >50% 8, 9, 10, critically ill patients might survive the acute stage in the ICU and enter the difficult stage of being weaned off MV and therefore, may require prolonged mechanical ventilation (PMV). Once a patient with LC is admitted to the ICU, the mortality rate can range from 34% to 69% 4.Īcute respiratory failure that requires mechanical ventilation (MV) is a major indication for the requirement of ICU admission for cirrhotic patients and is an independent risk factor of ICU mortality 5, 6, 7. In patients with previously compensated liver cirrhosis, several conditions such as variceal bleeding, ascites, hepato-renal syndrome, hepatic encephalopathy, hepato-pulmonary syndrome, spontaneous bacterial peritonitis, and severe sepsis may result in unstable clinical conditions that require admission to an intensive care unit (ICU). In Taiwan, liver cirrhosis mortalities jumped from 3723 in the 1980s to 6243 in 2010s 1. The health burden of liver cirrhosis (LC) has significantly increased worldwide 1 it resulted in one million mortalities in 2010 according to the Global Burden of Disease Study 2010 and is estimated to cost 31 million Disability Adjusted Life Years (DALYs) 2, 3. MELD scores may be useful predictors of mortality in these patients. In conclusion, the in-hospital mortality of patients with high MELD scores who required PMV was high. Based on the hospital database, risk factor analysis revealed that patients who died had significant higher MELD score than the survivors (18.9 vs 13.7, p = 0.036) and patients with MELD score of >23 had higher risk of mortality than patients with MELD score of ≤23 (adjusted OR:9.26, 95% CI: 1.96–43.8). The mortality was higher in patients with LC (19.5%) than those without LC (18.12%), though not statistically significant (p = 0.0622).
Model for End-Stage Liver Disease (MELD) score was calculated. Based on the NHIRD database of PMV cases, patients were age-gender matched in a ratio of 1:2 for patients with and without LC. The in-hospital mortality was significantly higher than in patients without LC. The hospital database yielded 58 LC patients (mean age: 65.3 years men: 65.5%). This retrospective study aimed to investigate the outcome and mortality risk factors in patients with liver cirrhosis (LC) who required prolonged mechanical ventilation (PMV) between 20 from two databases: Taiwan’s National Health Insurance Research Database (NHIRD) and a hospital database. Acute respiratory failure requiring mechanical ventilation is a major indicator of intensive care unit (ICU) admissions in cirrhotic patients and is an independent risk factor for ICU mortality.
0 kommentar(er)
