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Thématique :
- Foie
Originalité :
Intermédiaire
Solidité :
Intermédiaire
Doit faire évoluer notre pratique :
Dans certains cas
 
 
Nom du veilleur :
Docteur Jean-Louis PAYEN
Coup de coeur :
 
 
Journal of Hepatology
  2018/10  
 
  2018 Oct;69(4):803-809.  
  doi: 10.1016/j.jhep.2018.04.025.  
 
  The intensive care unit course and outcome in acute-on-chronic liver failure are comparable to other populations  
 
  Meersseman P, Langouche L, du Plessis J, Korf H, Mekeirele M, Laleman W, Nevens F, Wilmer A, Van den Berghe G, van der Merwe SW  
  https://www.ncbi.nlm.nih.gov/pubmed/29730473  
 
 

Abstract

BACKGROUND & AIMS:

Acute-on-chronic liver failure (ACLF) is characterized by acute decompensation of cirrhosis, development of organ failure and high short-term mortality. Whether the outcome in patients admitted to the intensive care unit (ICU) with ACLF differs from other ICU populations is unknown. We compared the clinical course and host response in ICU patients with or without ACLF, matched for baseline severity of illness scores and characteristics.

METHODS:

From the large prospective EPaNIC randomized control trial database (n = 4,640), 133 patients were identified with cirrhosis of whom 71 fulfilled the Chronic Liver Failure Consortium criteria for ACLF. These patients were matched for type and severity of illness and demographics to 71 septic and 71 medical ICU patients from the same database without chronic liver disease. Clinical, biochemical and outcome parameters were compared in this cohort study of 213 patients. In a subset of 100 patients, day 1 serum cytokines were quantified.

RESULTS:

The outcome of ACLF, when compared to septic or medical ICU patients, matched for baseline parameters of illness severity, was similar regarding length of ICU stay, development of new infections, organ failure and septic shock. ICU, hospital and 90-day mortality were similar between the groups. C-reactive protein and platelet levels were lower in patients with ACLF throughout the first week. Cytokines, including IL-10, IL-1β, IL-6, and IL-8, were similarly elevated in ACLF and septic ICU patients on day 1. However, TNF-α levels were higher in patients with ACLF.

CONCLUSION:

Patients with ACLF admitted to the ICU showed comparable clinical and ICU outcomes as ICU patients without chronic liver disease, but with similar baseline severity of illness characteristics. This suggests that ICU admission criteria should not be different in ACLF populations.

LAY SUMMARY:

Liver function may abruptly deteriorate in patients with chronic liver disease with cirrhosis, often resulting in these patients being admitted to an intensive care unit (ICU) with organ failure. Previous studies have indicated that this sudden deterioration, called acute-on-chronic liver failure is associated with very high mortality rates, which often resulted in deferred ICU care because of a perception of futility. Our study now shows that the ICU course and outcome are not different when patients with acute-on-chronic liver failure are compared to other ICU patients matched for severity of illness. This demonstrates that patients with acute-on-chronic liver failure deserve the same ICU care given to other ICU populations.

 
Question posée
 
L’évolution en réanimation des patients présentant une insuffisance hépatique aiguë sur hépatopathie chronique est-elle la même que chez les autres patients ?
 
Question posée
 
Cette étude suggère que l’évolution est la même chez ces deux types de patients quand les critères d’admission sont les mêmes.
 
Commentaires

Sous réserve d’une effectif de 71 patients dans chaque groupe, cette étude « tord le cou » des a priori très négatifs des réanimateurs pour les patients atteints de cirrhose qui présentent une décompensation justifiant un séjour en réanimation.

 
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