Bleeding complications in critically ill patients with liver cirrhosis

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Abstract

Background/Aims: Patients with liver cirrhosis (LC) are at risk for critical events leading to Intensive Care Unit (ICU) admission. Coagulopathy in cirrhotic patients is complex and can lead to bleeding as well as thrombosis. The aim of this study was to investigate bleeding complications in critically ill patients with LC admitted to a medical ICU (MICU). Methods: All adult patients admitted to our MICU with a diagnosis of LC from January 2006 to December 2012 were retrospectively assessed. Patients with major bleeding at the time of MICU admission were excluded from the analysis. Results: A total of 205 patients were included in the analysis. The median patient age was 62 years, and 69.3% of the patients were male. The most common reason for MICU admission was acute respiratory failure (45.4%), followed by sepsis (27.3%). Major bleeding occurred in 25 patients (12.2%). The gastrointestinal tract was the most common site of bleeding (64%), followed by the respiratory tract (20%). In a multivariate analysis, a low platelet count at MICU admission (odds ratio [OR], 0.98; 95% confidence interval [CI], 0.97 to 0.99) and sepsis (OR, 8.35; 95% CI, 1.04 to 67.05) were independent risk factors for major bleeding. The ICU fatality rate was significantly greater among patients with major bleeding (84.0% vs. 58.9%, respectively; p = 0.015). Conclusions: Major bleeding occurred in 12.2% of critically ill cirrhotic patients admitted to the MICU. A low platelet count at MICU admission and sepsis were associated with an increased risk of major bleeding during the MICU stay. Further study is needed to better understand hemostasis in critically ill patients with LC.

Original languageEnglish
Pages (from-to)288-295
Number of pages8
JournalKorean Journal of Internal Medicine
Volume31
Issue number2
DOIs
StatePublished - Mar 2016

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Critical Illness
Liver Cirrhosis
Hemorrhage
Intensive Care Units
Sepsis
Platelet Count
Odds Ratio
Confidence Intervals
Bleeding Time
Hemostasis
Respiratory Insufficiency
Respiratory System
Gastrointestinal Tract
Thrombosis
Multivariate Analysis

Keywords

  • Hemorrhage
  • Intensive care unit
  • Liver cirrhosis
  • Risk factors

Cite this

@article{7b9abace160040469840a0b2f8135610,
title = "Bleeding complications in critically ill patients with liver cirrhosis",
abstract = "Background/Aims: Patients with liver cirrhosis (LC) are at risk for critical events leading to Intensive Care Unit (ICU) admission. Coagulopathy in cirrhotic patients is complex and can lead to bleeding as well as thrombosis. The aim of this study was to investigate bleeding complications in critically ill patients with LC admitted to a medical ICU (MICU). Methods: All adult patients admitted to our MICU with a diagnosis of LC from January 2006 to December 2012 were retrospectively assessed. Patients with major bleeding at the time of MICU admission were excluded from the analysis. Results: A total of 205 patients were included in the analysis. The median patient age was 62 years, and 69.3{\%} of the patients were male. The most common reason for MICU admission was acute respiratory failure (45.4{\%}), followed by sepsis (27.3{\%}). Major bleeding occurred in 25 patients (12.2{\%}). The gastrointestinal tract was the most common site of bleeding (64{\%}), followed by the respiratory tract (20{\%}). In a multivariate analysis, a low platelet count at MICU admission (odds ratio [OR], 0.98; 95{\%} confidence interval [CI], 0.97 to 0.99) and sepsis (OR, 8.35; 95{\%} CI, 1.04 to 67.05) were independent risk factors for major bleeding. The ICU fatality rate was significantly greater among patients with major bleeding (84.0{\%} vs. 58.9{\%}, respectively; p = 0.015). Conclusions: Major bleeding occurred in 12.2{\%} of critically ill cirrhotic patients admitted to the MICU. A low platelet count at MICU admission and sepsis were associated with an increased risk of major bleeding during the MICU stay. Further study is needed to better understand hemostasis in critically ill patients with LC.",
keywords = "Hemorrhage, Intensive care unit, Liver cirrhosis, Risk factors",
author = "Jaeyoung Cho and Choi, {Sun Mi} and Yu, {Su Jong} and Park, {Young Sik} and Lee, {Chang Hoon} and Sang-Min Lee and Jae-Joon Yim and Yoo, {Chul Gyu} and Youngwhan Kim and Sungkoo Han and Jinwoo Lee",
year = "2016",
month = "3",
doi = "10.3904/kjim.2014.152",
language = "English",
volume = "31",
pages = "288--295",
journal = "The Korean journal of internal medicine",
issn = "1226-3303",
publisher = "Korean Association of Internal Medicine",
number = "2",

}

TY - JOUR

T1 - Bleeding complications in critically ill patients with liver cirrhosis

AU - Cho, Jaeyoung

AU - Choi, Sun Mi

AU - Yu, Su Jong

AU - Park, Young Sik

AU - Lee, Chang Hoon

AU - Lee, Sang-Min

AU - Yim, Jae-Joon

AU - Yoo, Chul Gyu

AU - Kim, Youngwhan

AU - Han, Sungkoo

AU - Lee, Jinwoo

PY - 2016/3

Y1 - 2016/3

N2 - Background/Aims: Patients with liver cirrhosis (LC) are at risk for critical events leading to Intensive Care Unit (ICU) admission. Coagulopathy in cirrhotic patients is complex and can lead to bleeding as well as thrombosis. The aim of this study was to investigate bleeding complications in critically ill patients with LC admitted to a medical ICU (MICU). Methods: All adult patients admitted to our MICU with a diagnosis of LC from January 2006 to December 2012 were retrospectively assessed. Patients with major bleeding at the time of MICU admission were excluded from the analysis. Results: A total of 205 patients were included in the analysis. The median patient age was 62 years, and 69.3% of the patients were male. The most common reason for MICU admission was acute respiratory failure (45.4%), followed by sepsis (27.3%). Major bleeding occurred in 25 patients (12.2%). The gastrointestinal tract was the most common site of bleeding (64%), followed by the respiratory tract (20%). In a multivariate analysis, a low platelet count at MICU admission (odds ratio [OR], 0.98; 95% confidence interval [CI], 0.97 to 0.99) and sepsis (OR, 8.35; 95% CI, 1.04 to 67.05) were independent risk factors for major bleeding. The ICU fatality rate was significantly greater among patients with major bleeding (84.0% vs. 58.9%, respectively; p = 0.015). Conclusions: Major bleeding occurred in 12.2% of critically ill cirrhotic patients admitted to the MICU. A low platelet count at MICU admission and sepsis were associated with an increased risk of major bleeding during the MICU stay. Further study is needed to better understand hemostasis in critically ill patients with LC.

AB - Background/Aims: Patients with liver cirrhosis (LC) are at risk for critical events leading to Intensive Care Unit (ICU) admission. Coagulopathy in cirrhotic patients is complex and can lead to bleeding as well as thrombosis. The aim of this study was to investigate bleeding complications in critically ill patients with LC admitted to a medical ICU (MICU). Methods: All adult patients admitted to our MICU with a diagnosis of LC from January 2006 to December 2012 were retrospectively assessed. Patients with major bleeding at the time of MICU admission were excluded from the analysis. Results: A total of 205 patients were included in the analysis. The median patient age was 62 years, and 69.3% of the patients were male. The most common reason for MICU admission was acute respiratory failure (45.4%), followed by sepsis (27.3%). Major bleeding occurred in 25 patients (12.2%). The gastrointestinal tract was the most common site of bleeding (64%), followed by the respiratory tract (20%). In a multivariate analysis, a low platelet count at MICU admission (odds ratio [OR], 0.98; 95% confidence interval [CI], 0.97 to 0.99) and sepsis (OR, 8.35; 95% CI, 1.04 to 67.05) were independent risk factors for major bleeding. The ICU fatality rate was significantly greater among patients with major bleeding (84.0% vs. 58.9%, respectively; p = 0.015). Conclusions: Major bleeding occurred in 12.2% of critically ill cirrhotic patients admitted to the MICU. A low platelet count at MICU admission and sepsis were associated with an increased risk of major bleeding during the MICU stay. Further study is needed to better understand hemostasis in critically ill patients with LC.

KW - Hemorrhage

KW - Intensive care unit

KW - Liver cirrhosis

KW - Risk factors

UR - http://www.scopus.com/inward/record.url?scp=84960110574&partnerID=8YFLogxK

U2 - 10.3904/kjim.2014.152

DO - 10.3904/kjim.2014.152

M3 - Article

C2 - 26805633

AN - SCOPUS:84960110574

VL - 31

SP - 288

EP - 295

JO - The Korean journal of internal medicine

JF - The Korean journal of internal medicine

SN - 1226-3303

IS - 2

ER -