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Cirrhotic Patients Admitted to the ICU With Septic Shock

Factors Predicting Short and Long-Term Outcome

Baudry, Thomas*; Hernu, Romain*; Valleix, Baptiste*; Jahandiez, Vincent*; Faucher, Etienne*; Simon, Marie*; Cour, Martin*,†; Argaud, Laurent*,†

doi: 10.1097/SHK.0000000000001282
Clinical Science Aspects
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ABSTRACT Cirrhotic patients with septic shock have a poor prognosis in ICU compared to general population of critically ill patients. Little is known about long-term outcome in these patients. We performed a retrospective analysis of a prospective cohort of cirrhotic patients with septic shock. The aim of this study was to describe both short and long-term outcomes and to evaluate factors predicting mortality. Data from 149 patients were analyzed (mean age: 60 ± 11 years, sex ratio: 2.4). Mortality rate in the ICU was 54% and at 1 year it was 73%. Among factors associated with adverse outcome, independent factors predicting ICU mortality were early need for renal replacement therapy (odds ratios, OR 13.95, 95% confidence interval, CI 3.30; 59.03) and arterial lactate >5 mmol.L−1 (OR 7.27, 95% CI 2.92; 18.10), and early use of mechanical ventilation (OR 3.05, 95% CI 1.08; 8.58). For 1-year mortality, independent prognostic factors were the need for renal replacement therapy during ICU stay (OR 9.60, 95% CI 2.90; 31.82), prothrombin time ≤40% (OR 3.47, 95% CI 1.43; 8.43), and Charlson score (OR 1.36 per point, 95% CI 1.11; 1.67). The results emphasize the poor prognosis of cirrhotic patients with septic shock admitted to the ICU. The need for organ supports appears to be a better predictor of short-term outcome than the underlying hepatic disease. Renal replacement therapy is associated with both short and long-term outcomes.

*Service de Réanimation Médicale, Hospices Civils de Lyon, Hôpital Edouard Herriot, Lyon, France

Faculté de Médecine Lyon-Est, Université de Lyon, Université Claude Bernard Lyon 1, Lyon, France

Address reprint requests to Laurent Argaud, MD, PhD, Service de Réanimation Médicale, Hôpital Edouard Herriot, 5, Place d’Arsonval, 69437 Lyon Cedex 03, France. E-mail: laurent.argaud@chu-lyon.fr

Received 31 August, 2018

Revised 17 September, 2018

Accepted 24 October, 2018

Authors’ contribution: TB and LA conceived the study, participated in the analysis and interpretation of the data, and drafted the manuscript. TB and BV were involved in acquisition of data. RH, MC, VJ, EF, and MS made substantial contributions to interpretation of data and revised critically the manuscript for important intellectual content. All authors read and approved the final manuscript.

Source of funding: None

Conflicts of interest: The authors report no conflicts of interest.

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© 2019 by the Shock Society