TY  - JOUR
A1  - Schulz, Martin S.
A1  - Mengers, Jan
A1  - Gu, Wenyi
A1  - Drolz, Andreas
A1  - Ferstl, Philip
A1  - Amoros, Alex
A1  - Uschner, Frank Erhard
A1  - Ackermann, Nora
A1  - Guttenberg, Georg
A1  - Queck, Alexander David Roger
A1  - Brol, Maximilian
A1  - Graf, Christiana
A1  - Stoffers, Philipp Clemens
A1  - Laguna de la Vera, Anna-Lena
A1  - Cremonese, Carla-Luisa Elsa
A1  - Erasmus, Hans-Peter
A1  - Welker, Martin-Walter
A1  - Grünewaldt, Achim Bernd
A1  - Arroyo, Vicente
A1  - Bojunga, Jörg
A1  - Fernandez, Javier
A1  - Zeuzem, Stefan
A1  - Kluwe, Johannes
A1  - Peiffer, Kai-Henrik
A1  - Welsch, Christoph
A1  - Fuhrmann, Valentin
A1  - Rohde, Gernot Gerhard Ulrich
A1  - Trebicka, Jonel
T1  - Pulmonary impairment independently determines mortality in critically ill patients with acute-on-chronic liver failure
T2  - Liver international
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.
KW  - ACLF
KW  - acute-on-chronic liver failure
KW  - CLIF-C ACLF score
KW  - CLIF-C ACLF-R score
KW  - mechanical ventilation
KW  - pulmonary failure
KW  - respiratory failure
Y1  - 2022
UR  - http://publikationen.ub.uni-frankfurt.de/frontdoor/index/index/docId/73506
UR  - https://nbn-resolving.org/urn:nbn:de:hebis:30:3-735066
SN  - 1478-3231
N1  - Open Access funding enabled and organized by Projekt DEAL.
VL  - 43
IS  - 1
SP  - 180
EP  - 193
PB  - Wiley-Blackwell
CY  - Oxford
ER  -