Prognosis of cirrhotic patients admitted to Emergency Departments: A multicenter study.
Javaud N, Bonnin L, Lapostolle F, Boubaya M, Bardis A, Dufau R, Ghazali A, Reuter PG, Pateron D, Adnet F.
Am J Emerg Med. 2019 Jul;37(7):1317-1321. doi: 10.1016/j.ajem.2018.10.008. Epub 2018 Oct 12. PMID: 30337088
Abstract
Objectives: Life threatening complications can occur at any stage of cirrhosis progression. There are few studies on the prognosis of cirrhotic patients managed in an Emergency Department (ED) although management of patients will occur in the ED. The objective of our study was to determine the risk factors for mortality in cirrhotic patients who visited to the ED.
Methods: All cirrhotic patients attending ED in three different university hospitals of Assistance Publique – Hôpitaux de Paris between January 2014 and June 2015 were identified by a retrospective analysis of digital records and included in the study. The primary end-point was 30-day mortality in all cirrhotic patients who visited the ED.
Results: A total of 609 ED visits were analyzed among 224 patients: 115 (51%) presented a cirrhosis of alcoholic origin, 43 (19%) were caused by Hepatitis C, 28 (13%) of mixed origin (viral and alcoholic), 17 (8%) were caused by Hepatitis B and 21 (9%) of other origins. Fifty-five (25%) of these patients died within 30 days of their initial presentation to the ED. In multivariate analysis, the age (Odds Ratio: 1.04 [1.01-1.07]), cirrhosis associated with hepatocellular carcinoma (OR: 3.07 [1.37-6.91]), serum creatinine at admission (OR: 1.01 [1.01-1.02]), serum bilirubin at admission (OR: 1.01 [1.01-1.02]) and health impairment (OR: 2.57 [1.28-5.16]) were associated with mortality.
Conclusions: The mortality rate of cirrhotic patients attending an ED was high. The prognosis of cirrhotic patients admitted to the ED depended on the severity of the liver and other organ dysfunction. The presence of a hepatocellular carcinoma on admission was also a risk factor for death.
Keywords: Ascites; Cirrhotic patients; Emergency department; Gastrointestinal bleeding.
