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Pulmonary impairment independently determines mortality in critically ill patients with acute-on-chronic liver failure

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Pulmonary impairment independently determines mortality in critically ill patients with acute-on-chronic liver failure. / Schulz, Martin S; Mengers, Jan; Gu, Wenyi; Drolz, Andreas; Ferstl, Philip G; Amoros, Alex; Uschner, Frank E; Ackermann, Nora; Guttenberg, Georg; Queck, Alexander; Brol, Maximilian J; Graf, Christiana; Stoffers, Philipp; de la Vera, Anna-Lena Laguna; Cremonese, Carla; Erasmus, Hans-Peter; Welker, Martin W; Grünewaldt, Achim; Arroyo, Vincente; Bojunga, Jörg; Fernandez, Javier; Zeuzem, Stefan; Kluwe, Johannes; Peiffer, Kai-Hendrik; Welsch, Christoph; Fuhrmann, Valentin; Rohde, Gernot; Trebicka, Jonel.

In: LIVER INT, Vol. 43, No. 1, 01.2023, p. 180-193.

Research output: SCORING: Contribution to journal › SCORING: Journal article › Research › peer-review

Harvard

Schulz, MS, Mengers, J, Gu, W, Drolz, A, Ferstl, PG, Amoros, A, Uschner, FE, Ackermann, N, Guttenberg, G, Queck, A, Brol, MJ, Graf, C, Stoffers, P, de la Vera, A-LL, Cremonese, C, Erasmus, H-P, Welker, MW, Grünewaldt, A, Arroyo, V, Bojunga, J, Fernandez, J, Zeuzem, S, Kluwe, J, Peiffer, K-H, Welsch, C, Fuhrmann, V, Rohde, G & Trebicka, J 2023, 'Pulmonary impairment independently determines mortality in critically ill patients with acute-on-chronic liver failure', LIVER INT, vol. 43, no. 1, pp. 180-193. https://doi.org/10.1111/liv.15343

APA

Schulz, M. S., Mengers, J., Gu, W., Drolz, A., Ferstl, P. G., Amoros, A., Uschner, F. E., Ackermann, N., Guttenberg, G., Queck, A., Brol, M. J., Graf, C., Stoffers, P., de la Vera, A-L. L., Cremonese, C., Erasmus, H-P., Welker, M. W., Grünewaldt, A., Arroyo, V., ... Trebicka, J. (2023). Pulmonary impairment independently determines mortality in critically ill patients with acute-on-chronic liver failure. LIVER INT, 43(1), 180-193. https://doi.org/10.1111/liv.15343

Vancouver

Schulz MS, Mengers J, Gu W, Drolz A, Ferstl PG, Amoros A et al. Pulmonary impairment independently determines mortality in critically ill patients with acute-on-chronic liver failure. LIVER INT. 2023 Jan;43(1):180-193. https://doi.org/10.1111/liv.15343

Bibtex

@article{f33f6a5439ca403dae32a239564d8617,
title = "Pulmonary impairment independently determines mortality in critically ill patients with acute-on-chronic liver failure",
abstract = "BACKGROUND & AIMS: In ACLF patients, an adequate risk stratification is essential, especially for liver transplant allocation, since ACLF is associated with high short-term mortality. The CLIF-C ACLF score is the best prognostic model to predict outcome in ACLF patients. While lung failure is generally regarded as signum malum in ICU care, this study aims to evaluate and quantify the role of pulmonary impairment on outcome in ACLF patients.METHODS: In this retrospective study, 498 patients with liver cirrhosis and admission to IMC/ICU were included. ACLF was defined according to EASL-CLIF criteria. Pulmonary impairment was classified into three groups: unimpaired ventilation, need for mechanical ventilation and defined pulmonary failure. These factors were analysed in different cohorts, including a propensity score-matched ACLF cohort.RESULTS: Mechanical ventilation and pulmonary failure were identified as independent risk factors for increased short-term mortality. In matched ACLF patients, the presence of pulmonary failure showed the highest 28-day mortality (83.7%), whereas mortality rates in ACLF with mechanical ventilation (67.3%) and ACLF without pulmonary impairment (38.8%) were considerably lower (p < .001). Especially in patients with pulmonary impairment, the CLIF-C ACLF score showed poor predictive accuracy. Adjusting the CLIF-C ACLF score for the grade of pulmonary impairment improved the prediction significantly.CONCLUSIONS: This study highlights that not only pulmonary failure but also mechanical ventilation is associated with worse prognosis in ACLF patients. The grade of pulmonary impairment should be considered in the risk assessment in ACLF patients. The new score may be useful in the selection of patients for liver transplantation.",
keywords = "Humans, Retrospective Studies, Acute-On-Chronic Liver Failure, Critical Illness, Liver Cirrhosis/complications, Prognosis, Lung",
author = "Schulz, {Martin S} and Jan Mengers and Wenyi Gu and Andreas Drolz and Ferstl, {Philip G} and Alex Amoros and Uschner, {Frank E} and Nora Ackermann and Georg Guttenberg and Alexander Queck and Brol, {Maximilian J} and Christiana Graf and Philipp Stoffers and {de la Vera}, {Anna-Lena Laguna} and Carla Cremonese and Hans-Peter Erasmus and Welker, {Martin W} and Achim Gr{\"u}newaldt and Vincente Arroyo and J{\"o}rg Bojunga and Javier Fernandez and Stefan Zeuzem and Johannes Kluwe and Kai-Hendrik Peiffer and Christoph Welsch and Valentin Fuhrmann and Gernot Rohde and Jonel Trebicka",
note = "{\textcopyright} 2022 The Authors. Liver International published by John Wiley & Sons Ltd.",
year = "2023",
month = jan,
doi = "10.1111/liv.15343",
language = "English",
volume = "43",
pages = "180--193",
journal = "LIVER INT",
issn = "1478-3223",
publisher = "Wiley-Blackwell",
number = "1",

}

RIS

TY - JOUR

T1 - Pulmonary impairment independently determines mortality in critically ill patients with acute-on-chronic liver failure

AU - Schulz, Martin S

AU - Mengers, Jan

AU - Gu, Wenyi

AU - Drolz, Andreas

AU - Ferstl, Philip G

AU - Amoros, Alex

AU - Uschner, Frank E

AU - Ackermann, Nora

AU - Guttenberg, Georg

AU - Queck, Alexander

AU - Brol, Maximilian J

AU - Graf, Christiana

AU - Stoffers, Philipp

AU - de la Vera, Anna-Lena Laguna

AU - Cremonese, Carla

AU - Erasmus, Hans-Peter

AU - Welker, Martin W

AU - Grünewaldt, Achim

AU - Arroyo, Vincente

AU - Bojunga, Jörg

AU - Fernandez, Javier

AU - Zeuzem, Stefan

AU - Kluwe, Johannes

AU - Peiffer, Kai-Hendrik

AU - Welsch, Christoph

AU - Fuhrmann, Valentin

AU - Rohde, Gernot

AU - Trebicka, Jonel

N1 - © 2022 The Authors. Liver International published by John Wiley & Sons Ltd.

PY - 2023/1

Y1 - 2023/1

N2 - BACKGROUND & AIMS: In ACLF patients, an adequate risk stratification is essential, especially for liver transplant allocation, since ACLF is associated with high short-term mortality. The CLIF-C ACLF score is the best prognostic model to predict outcome in ACLF patients. While lung failure is generally regarded as signum malum in ICU care, this study aims to evaluate and quantify the role of pulmonary impairment on outcome in ACLF patients.METHODS: In this retrospective study, 498 patients with liver cirrhosis and admission to IMC/ICU were included. ACLF was defined according to EASL-CLIF criteria. Pulmonary impairment was classified into three groups: unimpaired ventilation, need for mechanical ventilation and defined pulmonary failure. These factors were analysed in different cohorts, including a propensity score-matched ACLF cohort.RESULTS: Mechanical ventilation and pulmonary failure were identified as independent risk factors for increased short-term mortality. In matched ACLF patients, the presence of pulmonary failure showed the highest 28-day mortality (83.7%), whereas mortality rates in ACLF with mechanical ventilation (67.3%) and ACLF without pulmonary impairment (38.8%) were considerably lower (p < .001). Especially in patients with pulmonary impairment, the CLIF-C ACLF score showed poor predictive accuracy. Adjusting the CLIF-C ACLF score for the grade of pulmonary impairment improved the prediction significantly.CONCLUSIONS: This study highlights that not only pulmonary failure but also mechanical ventilation is associated with worse prognosis in ACLF patients. The grade of pulmonary impairment should be considered in the risk assessment in ACLF patients. The new score may be useful in the selection of patients for liver transplantation.

AB - BACKGROUND & AIMS: In ACLF patients, an adequate risk stratification is essential, especially for liver transplant allocation, since ACLF is associated with high short-term mortality. The CLIF-C ACLF score is the best prognostic model to predict outcome in ACLF patients. While lung failure is generally regarded as signum malum in ICU care, this study aims to evaluate and quantify the role of pulmonary impairment on outcome in ACLF patients.METHODS: In this retrospective study, 498 patients with liver cirrhosis and admission to IMC/ICU were included. ACLF was defined according to EASL-CLIF criteria. Pulmonary impairment was classified into three groups: unimpaired ventilation, need for mechanical ventilation and defined pulmonary failure. These factors were analysed in different cohorts, including a propensity score-matched ACLF cohort.RESULTS: Mechanical ventilation and pulmonary failure were identified as independent risk factors for increased short-term mortality. In matched ACLF patients, the presence of pulmonary failure showed the highest 28-day mortality (83.7%), whereas mortality rates in ACLF with mechanical ventilation (67.3%) and ACLF without pulmonary impairment (38.8%) were considerably lower (p < .001). Especially in patients with pulmonary impairment, the CLIF-C ACLF score showed poor predictive accuracy. Adjusting the CLIF-C ACLF score for the grade of pulmonary impairment improved the prediction significantly.CONCLUSIONS: This study highlights that not only pulmonary failure but also mechanical ventilation is associated with worse prognosis in ACLF patients. The grade of pulmonary impairment should be considered in the risk assessment in ACLF patients. The new score may be useful in the selection of patients for liver transplantation.

KW - Humans

KW - Retrospective Studies

KW - Acute-On-Chronic Liver Failure

KW - Critical Illness

KW - Liver Cirrhosis/complications

KW - Prognosis

KW - Lung

U2 - 10.1111/liv.15343

DO - 10.1111/liv.15343

M3 - SCORING: Journal article

C2 - 35727853

VL - 43

SP - 180

EP - 193

JO - LIVER INT

JF - LIVER INT

SN - 1478-3223

IS - 1

ER -