Outcomes for patients with alcohol-related liver disease admitted to Scottish intensive care units 2010-2018

Alcohol-related liver disease is recognised as a major cause of liver-related morbidity and mortality. Our aim was to report the prevalence of, and outcomes from, alcohol-related liver disease after admission to ICUs in Scotland.

We performed a secondary data analysis using linked Scottish national databases of all adult general ICUs in Scotland. We compared emergency non-surgical patients admitted to ICU with and without alcohol-related liver disease. The primary outcome was ICU mortality, and secondary outcomes were ICU admission rate ratio; 60-day mortality; 2-year mortality; duration of ICU and hospital stay; and need for hospital readmission.

Of the 49,420/103,103 (47.9%) patients admitted to ICU with emergency non-surgical diagnoses between 2010 and 2018, we identified 2629/49,420 (5.3%) patients with alcohol-related liver disease. Patients with alcohol-related liver disease were more likely to receive three-organ support (14.0% vs. 10.0%, p < 0.001). Mortality in the ICU was higher in patients with alcohol-related liver disease (964/2629 (36.7%) vs. 10,517/46,791 (22.5%), respectively; aOR 2.03 (95%CI 1.85-2.24)). Patients with alcohol-related liver disease who specifically presented to ICU with a gastrointestinal bleed had a lower ICU mortality (95/487 (19.5%)). Sixty-day mortality of patients with alcohol-related liver disease increased with higher levels of organ support (186/516 (36.0%) mortality with zero organs supported vs. 162/196 (82.7%) mortality with three organs supported).

Early mortality was high in patients with alcohol-related liver disease who were admitted to ICU, especially if multi-organ support was required. However, nearly one-fifth of patients on multi-organ support survived to hospital discharge. Early mortality for patients with alcohol-related liver disease admitted with a gastrointestinal bleed was considerably lower and should be taken into consideration when considering management in ICU. In discussion with the patient and hepatologists, a trial of organ support with continuous re-evaluation may be appropriate.