{
  "abstract": "Introduction Liver cirrhosis is often perceived as having poor outcomes following Intensive Care Unit (ICU) admissions with prolonged length of stay. The aim was to assess the outcomes of patients with liver cirrhosis.Methods Retrospective review of adult patients admitted to ICU at Manchester Royal Infirmary with a coded diagnosis of cirrhosis between January 2018 and September 2022. ICU transfers from other hospitals for interventional radiological procedures such as Transjugular Intrahepatic Portosystemic shunt were excluded.Results 52 patients (32 (61.5%) male, mean age 51.6 (SD ± 11.4) years) were admitted to ICU. All patients were diagnosed with cirrhosis; 75% alcohol related, 9.6% Hepatitis C, 3.8% MASLD, 3.8% cryptogenic and 7.8% other causes. 51.9% patients were admitted following a GI bleed of which 74.1% were variceal. 67.3% of patients had decompensated cirrhosis, of which 22.6% were first presentations. 9.6% of patients were admitted with alcohol related hepatitis. The median ICU stay was 7 days (IQR 4-16). Patients with decompensation had a significantly longer length of stay compared to patients with a variceal bleed (14.1 days vs 6.3 days (p = 0.01, 95% CI -13.95 – -1.70)).16 (30.8%) patients died in ICU after a median ICU stay of 6.5 (IQR 2.5 – 12.75) days. Four more patients died in hospital after discharge from ICU. Total in-hospital mortality was 39%. 30% of patients with variceal bleeds, 31.4% of patients with decompensation (1 patient with an index presentation) and 40% of patients with alcoholic hepatitis died. There were no differences in mortality by age (p = 0.21), gender (p = 0.15) or deprivation (p = 0.77). Patients with a first presentation of decompensation were not significantly more likely to die (OR 0.24, p = 0.22). Patients who died had a significantly higher APACHE score (22.65 vs 16.80 (p = <0.001, 95% CI 2.62 – 9.08)), MELD (28.8 vs 16.9 (p = 0.022; 95% CI -23.51 – -0.40)) and Child Pugh (12.5 vs 9.4 (p = < 0.001, 95% CI -4.51 – -1.62)) scores.Conclusions Critically ill patients with cirrhosis on ICU have a high in-hospital mortality (approaching 40%), irrespective of age, sex, or with a first presentation of decompensation. Decompensated cirrhosis is associated with significantly longer ICU stays compared with variceal bleeding. Mortality is strongly associated with disease severity scores, underscoring the need for early risk stratification and targeted management strategies.",
  "authors": [
    {
      "affiliations": [
        "Manchester University NHS Foundation Trust, Manchester, United Kingdom",
        "University of Manchester, Manchester, United Kingdom"
      ],
      "name": "Huw Purssell"
    },
    {
      "affiliations": [
        "Manchester University NHS Foundation Trust, Manchester, United Kingdom"
      ],
      "name": "Hannah Morgan"
    },
    {
      "affiliations": [
        "Manchester University NHS Foundation Trust, Manchester, United Kingdom"
      ],
      "name": "Sophie Collinson"
    },
    {
      "affiliations": [
        "Manchester University NHS Foundation Trust, Manchester, United Kingdom"
      ],
      "name": "Shoneen Abbas"
    },
    {
      "affiliations": [
        "Manchester University NHS Foundation Trust, Manchester, United Kingdom"
      ],
      "name": "Anthony Wilson"
    },
    {
      "affiliations": [
        "Manchester University NHS Foundation Trust, Manchester, United Kingdom"
      ],
      "name": "Imran Patanwala"
    }
  ],
  "title": "P104 Liver cirrhosis survival on intensive care is best predicted by disease severity rather than demographics or first presentation",
  "uid": "7ebbc8d0-b698-5a8e-befe-c59c7d9bd76b"
}