Cirrhotics admitted to intensive care unit: the impact of acute renal failure on mortality

Background The exact role of renal dysfunction in critically ill cirrhotics admitted to an intensive care unit (ICU) has not been assessed extensively. Aim To evaluate the impact of acute renal failure (ARF) on 6 weeks mortality in cirrhotics admitted to ICU. Patients/methods Three hundred and twelve cirrhotics (182 male, mean age 49.6 +/- 11.5 years) were consecutively admitted during the study period. The patients (n = 128, 40%) (group 1) with ARF on admission and/or during ICU were compared with the patients whose ICU stay was not complicated with ARF (n=184, 60%) (group 2). At admission, 40 variables were available, whereas Child-Turcotte-Pugh, Model for End-stage Liver Disease, Acute Physiology and Chronic Health Evaluation II, Sequential Organ Failure Assessment and Failure Organ System scores on admission, were evaluated and compared by receiver operating characteristic curves. Results Group 1, compared with group 2 patients, had longer ICU stay (7 vs. 4 days, P=0.04) and required cardiovascular support more frequently with inotropes (90 vs. 75%), (P<0.001). Mortality was significantly higher in group 1, compared with group 2 (91 vs. 47%, P<0.001). At admission, group 1, compared with group 2, had significantly higher Child-Turcotte-Pugh (12 vs. 11), Acute Physiology and Chronic Health Evaluation 11 (22 vs. 17), Model for End-stage Liver Disease (31 vs. 21), Sequential Organ Failure Assessment 0 3 vs. 9) and Failure Organ System (3 vs. 2) scores (P<0.001). In group 1, factors independently associated with mortality were: higher FiO(2) (P=0.044), bilirubin (P=0.021) and creatinine (P=0.002) on admission. Mortality was not significantly different between those with ARF on admission, and those who developed ARF during ICU stay. Conclusion ARF at admission or during ICU stay is strongly predictive of mortality, which is high, despite supportive therapeutic interventions. Preventive measures are needed to prevent ARF, to improve prognosis. Eur J Gastroenterol Hepatol 21:744-750 (C) 2009 Wolters Kluwer Health vertical bar Lippincott Williams & Wilkins.