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The impact of liver cirrhosis on outcomes in trauma patients: A prospective study

Talving, Peep MD, PhD; Lustenberger, Thomas MD; Okoye, Obi T. MD; Lam, Lydia MD; Smith, Jennifer A. MD; Inaba, Kenji MD; Mohseni, Shahin MD; Chan, Linda PhD; Demetriades, Demetrios MD, PhD

Journal of Trauma and Acute Care Surgery: October 2013 - Volume 75 - Issue 4 - p 699–703
doi: 10.1097/TA.0b013e31829a2c19
Original Articles
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BACKGROUND The adverse effects of liver cirrhosis on outcomes following trauma has been established in retrospective series. In this study, however, we set out to evaluate prospectively the in-hospital outcome measures in this subgroup of trauma patients.

METHODS Prospective observational study of all patients admitted to the surgical intensive care unit of a Level I trauma center from January 2008 to December 2011. Cirrhotic trauma cases were matched with noncirrhotic controls in a 1:2 ratio. Matching criteria included age, sex, injury mechanism, vital signs at admission, Abbreviated Injury Scale (AIS) score for all body regions, and Injury Severity Score (ISS). Outcomes included in-hospital morbidity and mortality.

RESULTS During the 4-year study period, 92 (0.8%) of the 12,102 trauma admissions had liver cirrhosis. After matching, no differences with regard to demographic and clinical injury characteristics were noted comparing the cases and controls. The overall complication rate in cases and controls was 31.5% and 7.1%, respectively (p < 0.001). In-hospital mortality was significantly higher for cirrhotic patients compared with their noncirrhotic counterparts (20.7 vs. 6.5%, p = 0.001). Within the cirrhotic group, mortality increased significantly from 8.0% in Child-Pugh Class A to 32.3% in Class B and 45.5% in Class C (p = 0.003). Likewise, mortality was significantly higher for patients with a Model for End-Stage Liver Disease (MELD) score of 10 or greater versus less than 10 (30.0% vs. 9.5%; odds ratio, 4.07; 95% confidence interval, 1.23–13.45; p = 0.016).

CONCLUSION In this prospective investigation, liver cirrhosis is associated with adverse outcomes following trauma. Both stepwise increasing Child-Pugh and MELD scores predicted adjusted adverse outcomes. Injured patients with cirrhosis warrant aggressive monitoring and instant treatment after injury.

LEVEL OF EVIDENCE Prognostic study, level III.

From the Division of Acute Care Surgery (Trauma, Emergency Surgery and Surgical Critical Care), Department of Surgery, Keck School of Medicine, Los Angeles County + University of Southern California Medical Center, Los Angeles, California.

Submitted: February 12, 2013, Revised: April 16, 2013, Accepted: April 17, 2013.

This study was presented at the 70th Annual Meeting of the American Association for the Surgery of Trauma, September 14–17, 2011, in Chicago, Illinois.

Address for reprints: Peep Talving, MD, PhD, Surgery University of Southern California, Keck School of Medicine, Division of Acute Care Surgery (Trauma, Emergency Surgery and Surgical Critical Care) Los Angeles County General Hospital (LAC + USC) 1200 North State St, C5L100 Los Angeles, CA, 90033-4525; email: peep.talving@surgery.usc.edu.

© 2013 Lippincott Williams & Wilkins, Inc.