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Bacteremia, acute physiology and chronic health evaluation II and modified end stage liver disease are independent predictors of mortality in critically ill nontransplanted patients with acute on chronic liver failure.
Crit Care Med. 2010 Jan; 38(1):121-6.CC

Abstract

OBJECTIVES

To determine what physiological and biochemical factors predict development of bacteremia in nontransplanted patients with acute on chronic liver failure and, on diagnosis of bacteremia, what is the natural history of bacteremic patients versus control subjects (acute on chronic liver failure).

INTERVENTIONS

None.

DESIGN

Retrospective analysis of data collected prospectively and entered into a dedicated physiology database.

SETTING

Specialist liver intensive therapy unit.

PATIENTS

Critically ill non-transplanted patients with acute on chronic liver failure admitted between January 2003 and July 2005.

MEASUREMENTS AND MAIN RESULTS

One hundred eighty-four patients were defined with acute on chronic liver failure; 67 (36%) had bacteremia. One hundred seventeen (64%) patients did not (acute on chronic liver failure). Fifty-eight percent of isolates were Gram-negative organisms, 36% were Gram-positives, and 6% fungemia. Median time to first bacteremia was 8 days (range, 3-12 days). On admission (univariate), bacteremic patients had significantly higher Modified End Stage Liver Disease scores (27 vs. 24, p = .037), Acute Physiology and Chronic Health Evaluation II scores (23 vs. 21, p = .049), and greater degrees of encephalopathy (Glasgow Coma Scale score 10 vs. 12, p = .001). During their liver intensive therapy unit course, bacteremic patients had significantly greater requirements for renal replacement therapy (64% vs. 49%, p = .043), mechanical ventilation (88% vs. 68%, p = .002), and a longer median liver intensive therapy unit stay (16 vs. 5 days, p < .001). Survival to hospital discharge was worse in the bacteremic group (25% vs. 56%, p < .001). Multivariate analysis (logistic regression) was performed separately modeling with Acute Physiology and Chronic Health Evaluation II and Modified End Stage Liver Disease. In the first model, Acute Physiology and Chronic Health Evaluation II (odds ratio 1.24) and bacteremia (2.24) were independent predictors of mortality. In the later model, Modified End Stage Liver Disease (odds ratio, 1.06), requirement for renal replacement therapy (3.08), Glasgow Coma Scale (0.72), and bacteremia (2.30) were significant. Both models performed similarly (Modified End Stage Liver Disease area under the receiver operating characteristic curve, 0.864; Acute Physiology and Chronic Health Evaluation II, 0.862).

CONCLUSIONS

In nontransplanted patients with acute on chronic liver failure, bacteremia was associated with increased severity of illness on admission, greater requirements for organ support, and independently adversely impacted on survival. Higher Acute Physiology and Chronic Health Evaluation II and Modified End Stage Liver Disease scores were also independently predictive of mortality.

Authors+Show Affiliations

Division of Critical Care Medicine, University of Alberta, Edmonton, Canada. cjk2@ualberta.caNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article

Language

eng

PubMed ID

19770744

Citation

Karvellas, Constantine J., et al. "Bacteremia, Acute Physiology and Chronic Health Evaluation II and Modified End Stage Liver Disease Are Independent Predictors of Mortality in Critically Ill Nontransplanted Patients With Acute On Chronic Liver Failure." Critical Care Medicine, vol. 38, no. 1, 2010, pp. 121-6.
Karvellas CJ, Pink F, McPhail M, et al. Bacteremia, acute physiology and chronic health evaluation II and modified end stage liver disease are independent predictors of mortality in critically ill nontransplanted patients with acute on chronic liver failure. Crit Care Med. 2010;38(1):121-6.
Karvellas, C. J., Pink, F., McPhail, M., Austin, M., Auzinger, G., Bernal, W., Sizer, E., Kutsogiannis, D. J., Eltringham, I., & Wendon, J. A. (2010). Bacteremia, acute physiology and chronic health evaluation II and modified end stage liver disease are independent predictors of mortality in critically ill nontransplanted patients with acute on chronic liver failure. Critical Care Medicine, 38(1), 121-6. https://doi.org/10.1097/CCM.0b013e3181b42a1c
Karvellas CJ, et al. Bacteremia, Acute Physiology and Chronic Health Evaluation II and Modified End Stage Liver Disease Are Independent Predictors of Mortality in Critically Ill Nontransplanted Patients With Acute On Chronic Liver Failure. Crit Care Med. 2010;38(1):121-6. PubMed PMID: 19770744.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Bacteremia, acute physiology and chronic health evaluation II and modified end stage liver disease are independent predictors of mortality in critically ill nontransplanted patients with acute on chronic liver failure. AU - Karvellas,Constantine J, AU - Pink,Fred, AU - McPhail,Mark, AU - Austin,Mark, AU - Auzinger,Georg, AU - Bernal,William, AU - Sizer,Elizabeth, AU - Kutsogiannis,Demetrios J, AU - Eltringham,Ian, AU - Wendon,Julia A, PY - 2009/9/23/entrez PY - 2009/9/23/pubmed PY - 2010/1/16/medline SP - 121 EP - 6 JF - Critical care medicine JO - Crit Care Med VL - 38 IS - 1 N2 - OBJECTIVES: To determine what physiological and biochemical factors predict development of bacteremia in nontransplanted patients with acute on chronic liver failure and, on diagnosis of bacteremia, what is the natural history of bacteremic patients versus control subjects (acute on chronic liver failure). INTERVENTIONS: None. DESIGN: Retrospective analysis of data collected prospectively and entered into a dedicated physiology database. SETTING: Specialist liver intensive therapy unit. PATIENTS: Critically ill non-transplanted patients with acute on chronic liver failure admitted between January 2003 and July 2005. MEASUREMENTS AND MAIN RESULTS: One hundred eighty-four patients were defined with acute on chronic liver failure; 67 (36%) had bacteremia. One hundred seventeen (64%) patients did not (acute on chronic liver failure). Fifty-eight percent of isolates were Gram-negative organisms, 36% were Gram-positives, and 6% fungemia. Median time to first bacteremia was 8 days (range, 3-12 days). On admission (univariate), bacteremic patients had significantly higher Modified End Stage Liver Disease scores (27 vs. 24, p = .037), Acute Physiology and Chronic Health Evaluation II scores (23 vs. 21, p = .049), and greater degrees of encephalopathy (Glasgow Coma Scale score 10 vs. 12, p = .001). During their liver intensive therapy unit course, bacteremic patients had significantly greater requirements for renal replacement therapy (64% vs. 49%, p = .043), mechanical ventilation (88% vs. 68%, p = .002), and a longer median liver intensive therapy unit stay (16 vs. 5 days, p < .001). Survival to hospital discharge was worse in the bacteremic group (25% vs. 56%, p < .001). Multivariate analysis (logistic regression) was performed separately modeling with Acute Physiology and Chronic Health Evaluation II and Modified End Stage Liver Disease. In the first model, Acute Physiology and Chronic Health Evaluation II (odds ratio 1.24) and bacteremia (2.24) were independent predictors of mortality. In the later model, Modified End Stage Liver Disease (odds ratio, 1.06), requirement for renal replacement therapy (3.08), Glasgow Coma Scale (0.72), and bacteremia (2.30) were significant. Both models performed similarly (Modified End Stage Liver Disease area under the receiver operating characteristic curve, 0.864; Acute Physiology and Chronic Health Evaluation II, 0.862). CONCLUSIONS: In nontransplanted patients with acute on chronic liver failure, bacteremia was associated with increased severity of illness on admission, greater requirements for organ support, and independently adversely impacted on survival. Higher Acute Physiology and Chronic Health Evaluation II and Modified End Stage Liver Disease scores were also independently predictive of mortality. SN - 1530-0293 UR - https://www.unboundmedicine.com/medline/citation/19770744/Bacteremia_acute_physiology_and_chronic_health_evaluation_II_and_modified_end_stage_liver_disease_are_independent_predictors_of_mortality_in_critically_ill_nontransplanted_patients_with_acute_on_chronic_liver_failure_ L2 - https://dx.doi.org/10.1097/CCM.0b013e3181b42a1c DB - PRIME DP - Unbound Medicine ER -