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

Majeed, Ammar MD, PhD1,2; Majumdar, Avik MD, PhD1,3; Bailey, Michael PhD4,5; Kemp, William MD, PhD1,2; Bellomo, Rinaldo MD, PhD4; Pilcher, David MBBS4,5,6; Roberts, Stuart K. MBBS, MPH, MD1,2

doi: 10.1097/CCM.0000000000003902
Clinical Investigations
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Objectives: 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.

Design: Retrospective analysis of data captured prospectively in the Australian and New Zealand Intensive Care Society Centre for Outcome and Resource Evaluation Adult Patient Database.

Settings: One hundred eighty-three ICUs in Australia and New Zealand.

Patients: Consecutive admissions to these ICUs for upper gastrointestinal bleeding related to varices in patients with cirrhosis between January 1, 2005, and December 31, 2016.

Interventions: None.

Measurements and Main Results: 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).

Conclusions: 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.

1Department of Gastroenterology, The Alfred Hospital, Melbourne, VIC, Australia.

2Central Clinical School, Monash University, Melbourne, VIC, Australia.

3AW Morrow Gastroenterology and Liver Centre, Royal Prince Alfred Hospital, Sydney, NSW, Australia.

4Australian and New Zealand Intensive Care Research Centre (ANZIC RC), Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC, Australia.

5ANZICS Centre for Outcome and Resource Evaluation (CORE), Melbourne, VIC, Australia.

6Department of Intensive Care, The Alfred Hospital, Melbourne, VIC, Australia.

*See also p.1453.

Dr. Majeed helped with drafting of the article, interpretation of the data, and study concept. Dr. Majumdar helped with preparation and critical review of the article. Dr. Bailey helped with data acquisition, statistical analysis, and critical review of the article. Drs. Kemp and Bellomo helped with preparation and critical review of the article. Mr. Pilcher helped with data acquisition, review of the article, interpretation of the data, and study concept. Dr. Roberts helped with preparation and critical review of the article, and study concept.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal’s website (http://journals.lww.com/ccmjournal).

Supported, in part, by grants from the Alfred Hospital Department of Gastroenterology and the Australian and New Zealand Intensive Care Research Centre.

The authors have disclosed that they do not have any potential conflicts of interest.

For information regarding this article, E-mail: a.majeed@alfred.org.au

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