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Long-Term Mortality and Hospital Resource Use in ICU Patients With Alcohol-Related Liver Disease*

Lone, Nazir I., PhD1,2; Lee, Robert, MSc2; Walsh, Timothy S., MD1,2,3

doi: 10.1097/CCM.0000000000003421
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Objectives: Data describing long-term outcomes following ICU for patients with alcohol-related liver disease are scarce. We aimed to report long-term mortality and emergency hospital resource use for patients with alcohol-related liver disease and compare this with two comparator cohorts.

Design: Retrospective cohort study linking population registry data.

Setting: All adult general Scottish ICUs (2005–2010) serving 5 million population.

Patients: ICU patients with alcohol-related liver disease were compared with an unmatched cohort with Acute Physiology and Chronic Health Evaluation defined diagnoses of severe cardiovascular, respiratory, or renal comorbidity and a matched general ICU cohort.

Interventions: None.

Measurements and Main Results: Outcomes were 5-year mortality, emergency hospital resource use, and emergency hospital readmission. Multivariable regression was used to identify risk factors and adjust for confounders. Of 47,779 ICU admissions, 2,463 patients with alcohol-related liver disease and 3,590 patients with severe comorbidities were identified; 2,391(97.1%) were matched to a general ICU cohort. The alcohol-related liver disease cohort had greater 5-year mortality than comorbid (79.2% vs 75.3%; p < 0.001) and matched general (79.8% vs 63.3%; p < 0.001) cohorts. High liver Sequential Organ Failure Assessment score and three-organ support were associated with 90% 5-year mortality in alcohol-related liver disease patients. After confounder adjustment, alcohol-related liver disease patients had 31% higher hazard of death (adjusted hazard ratio, 1.31; 95% CI, 1.17–1.47; p < 0.001) and used greater resource than the severe comorbid comparator group. Findings were similar compared with the matched cohort.

Conclusions: ICU patients with alcohol-related liver disease have higher 5-year mortality and emergency readmission rates than ICU patients with other severe comorbidities and matched general ICU patients. These data can contribute to shared decision-making for alcohol-related liver disease patients.

1Department of Anaesthesia, Critical Care, and Pain Medicine, School of Clinical Sciences, University of Edinburgh, Edinburgh, United Kingdom.

2Usher Institute for Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, United Kingdom.

3MRC Centre for Inflammation Research, University of Edinburgh, Edinburgh, United Kingdom.

*See also p. 123.

This work was performed at the Usher Institute for Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, United Kingdom.

Ethical approval: Approvals were obtained from the relevant data-governing body (Privacy Advisory Committee, Information Services Division: reference 55/09). All data were anonymized prior to release to the researchers. The South East Scotland Research Ethics Committee granted a waiver (reference NR/1001AB14).

Dr. Lone had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. Drs. Lone and Walsh drafted the work. All authors contributed to conception and design of the work, data acquisition, and analysis. All authors contributed to interpretation of data for the work. All authors revised it critically for important intellectual content. All authors gave final approval of the version to be published. All authors agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

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Dr. Lone was supported by a fellowship from the Chief Scientist Office (CAF/08/12), and he received support for article research from the Research Councils UK. The remaining authors have disclosed that they do not have any potential conflicts of interest.

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