Declining Mortality of Cirrhotic Variceal Bleeding Requiring Admission to Intensive Care: A Binational Cohort Study.


Journal

Critical care medicine
ISSN: 1530-0293
Titre abrégé: Crit Care Med
Pays: United States
ID NLM: 0355501

Informations de publication

Date de publication:
10 2019
Historique:
pubmed: 16 7 2019
medline: 15 5 2020
entrez: 16 7 2019
Statut: ppublish

Résumé

We aimed to describe changes over time in admissions and outcomes, including length of stay, discharge destinations, and mortality of cirrhotic patients admitted to the ICU for variceal bleeding, and to compare it to the outcomes of those with other causes of ICU admissions. Retrospective analysis of data captured prospectively in the Australian and New Zealand Intensive Care Society Centre for Outcome and Resource Evaluation Adult Patient Database. One hundred eighty-three ICUs in Australia and New Zealand. Consecutive admissions to these ICUs for upper gastrointestinal bleeding related to varices in patients with cirrhosis between January 1, 2005, and December 31, 2016. None. ICU admissions for variceal bleeding in cirrhotic patients accounted for 4,003 (0.6%) of all 720,425 nonelective ICU admissions. The proportion of ICU admissions for variceal bleeding fell significantly from 0.8% (83/42,567) in 2005 to 0.4% (53/80,388) in 2016 (p < 0.001). Hospital mortality rate was significantly higher within admissions for variceal bleeding compared with nonelective ICU admissions (20.0% vs 15.7%; p < 0.0001), but decreased significantly over time, from 24.6% in 2005 to 15.8% in 2016 (annual decline odds ratio, 0.93; 95% CI, 0.90-0.96). There was no difference in the reduction in mortality from variceal bleeding over time between liver transplant and nontransplant centers (p = 0.26). Admission rate to ICU and mortality of cirrhotic patients with variceal bleeding has declined significantly over time compared with other causes of ICU admissions with the outcomes comparable between liver transplant and nontransplant centers.

Identifiants

pubmed: 31306178
doi: 10.1097/CCM.0000000000003902
doi:

Types de publication

Comparative Study Journal Article Research Support, Non-U.S. Gov't

Langues

eng

Sous-ensembles de citation

IM

Pagination

1317-1323

Commentaires et corrections

Type : CommentIn
Type : CommentIn
Type : CommentIn

Auteurs

Ammar Majeed (A)

Department of Gastroenterology, The Alfred Hospital, Melbourne, VIC, Australia.
Central Clinical School, Monash University, Melbourne, VIC, Australia.

Avik Majumdar (A)

Department of Gastroenterology, The Alfred Hospital, Melbourne, VIC, Australia.
AW Morrow Gastroenterology and Liver Centre, Royal Prince Alfred Hospital, Sydney, NSW, Australia.

Michael Bailey (M)

Australian and New Zealand Intensive Care Research Centre (ANZIC RC), Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC, Australia.
ANZICS Centre for Outcome and Resource Evaluation (CORE), Melbourne, VIC, Australia.

William Kemp (W)

Department of Gastroenterology, The Alfred Hospital, Melbourne, VIC, Australia.
Central Clinical School, Monash University, Melbourne, VIC, Australia.

Rinaldo Bellomo (R)

Australian and New Zealand Intensive Care Research Centre (ANZIC RC), Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC, Australia.

David Pilcher (D)

Australian and New Zealand Intensive Care Research Centre (ANZIC RC), Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC, Australia.
ANZICS Centre for Outcome and Resource Evaluation (CORE), Melbourne, VIC, Australia.
Department of Intensive Care, The Alfred Hospital, Melbourne, VIC, Australia.

Stuart K Roberts (SK)

Department of Gastroenterology, The Alfred Hospital, Melbourne, VIC, Australia.
Central Clinical School, Monash University, Melbourne, VIC, Australia.

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Classifications MeSH