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Bleeding complications in critically ill patients with liver cirrhosis
Jaeyoung Cho1, Sun Mi Choi1, Su Jong Yu2
1Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea.
Insights
Critically ill patients with liver cirrhosis (LC) face significant bleeding risks in the ICU. Low platelet counts and sepsis are key risk factors for major bleeding events.
Area of Science:
- Critical Care Medicine
- Hepatology
- Hematology
Background:
- Liver cirrhosis (LC) patients admitted to the Intensive Care Unit (ICU) are prone to critical events.
- Coagulopathy in LC is complex, increasing risks for both bleeding and thrombosis.
- Understanding bleeding complications in these patients is crucial for improving outcomes.
Purpose of the Study:
- To investigate the incidence and risk factors of major bleeding complications.
- To assess the outcomes of critically ill patients with liver cirrhosis admitted to a medical ICU (MICU).
Main Methods:
- Retrospective analysis of adult patients diagnosed with LC admitted to a MICU between January 2006 and December 2012.
- Exclusion of patients with major bleeding at the time of MICU admission.
- Multivariate analysis to identify independent risk factors for major bleeding.
Main Results:
- Of 205 patients analyzed, 12.2% experienced major bleeding.
- Gastrointestinal (64%) and respiratory (20%) tracts were the most common bleeding sites.
- Low platelet count (OR, 0.98) and sepsis (OR, 8.35) were independent risk factors for major bleeding.
- ICU fatality rate was significantly higher in patients with major bleeding (84.0%) compared to those without (58.9%).
Conclusions:
- Major bleeding affects over 12% of critically ill cirrhotic patients in the MICU.
- Low platelet count and sepsis are significant predictors of major bleeding.
- Further research is warranted to elucidate hemostasis mechanisms in critically ill LC patients.
Background/Aims:
Patients with liver cirrhosis (LC) are at risk for critical events leading to Intensive Care Unit (ICU) admission. Coagulopathy in cirrhotic patients is complex and can lead to bleeding as well as thrombosis. The aim of this study was to investigate bleeding complications in critically ill patients with LC admitted to a medical ICU (MICU).
Methods:
All adult patients admitted to our MICU with a diagnosis of LC from January 2006 to December 2012 were retrospectively assessed. Patients with major bleeding at the time of MICU admission were excluded from the analysis.
Results:
A total of 205 patients were included in the analysis. The median patient age was 62 years, and 69.3% of the patients were male. The most common reason for MICU admission was acute respiratory failure (45.4%), followed by sepsis (27.3%). Major bleeding occurred in 25 patients (12.2%). The gastrointestinal tract was the most common site of bleeding (64%), followed by the respiratory tract (20%). In a multivariate analysis, a low platelet count at MICU admission (odds ratio [OR], 0.98; 95% confidence interval [CI], 0.97 to 0.99) and sepsis (OR, 8.35; 95% CI, 1.04 to 67.05) were independent risk factors for major bleeding. The ICU fatality rate was significantly greater among patients with major bleeding (84.0% vs. 58.9%, respectively; p = 0.015).
Conclusions:
Major bleeding occurred in 12.2% of critically ill cirrhotic patients admitted to the MICU. A low platelet count at MICU admission and sepsis were associated with an increased risk of major bleeding during the MICU stay. Further study is needed to better understand hemostasis in critically ill patients with LC.
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