Cirrhotic patients admitted to the medical ICU (MICU) are associated with high mortality
rates and high resource utilization. This study identifies specific predictors of
increased mortality and resource utilization and uses them to develop and validate
prognostic models in cirrhotic patients admitted to the MICU.
Cirrhotic patients admitted to the MICU were identified from the Critical Care Section
database (January 1993 to October 1998). Clinical data were extracted from chart review
including hospital course variables, mortality, and length of stay (LOS). Total cost
per case (TCPC) was obtained from the Transition System INC: Multivariate logistic
and linear regression analyses identified the independent predictors of increased
mortality and resource utilization used for model building (MB) and model validation
(MV).
A total of 582 cases were randomized to the MB and MV groups. Each group contained
240 cases after exclusion criteria were applied. The MICU mortality rate was 36.6%,
and the in-hospital mortality rate was 49.0%. Acute physiology, age, and chronic health
evaluation (APACHE) III score (odds ratio [OR], 4.7; 95% confidence interval [CI],
2.70 to 8.16; p < 0.001), mechanical ventilation (OR, 4.57; 95% CI, 2.35 to 8.34);
p < 0.001), and the use of pressors (OR, 7.57; 95% CI, 4.35 to 13.18; p < 0.001) were
independent predictors of MICU mortality. APACHE III score (OR, 4.96; 95% CI, 2.97
to 8.29; p < 0.001), the use of pressors (OR, 6.55; 95% CI, 3.66 to 11.72; p < 0.001),
and acute renal failure (ARF) (OR, 4.31; 95% CI, 2.41 to 7.71; p < 0.001) were independent
predictors of in-hospital mortality. Increased LOS in the MICU was associated with
mechanical ventilation, ARF, bronchoscopy, bacteremia, use of pressors, transjugular
intrahepatic portosystemic shunt (TIPS), and never received cardiopulmonary resuscitation
(CPR) (p < 0.005). Source of admission, platelet transfusion, bacteremia, pneumonia,
and never received CPR were independently associated with increased total LOS (p <
0.001). Mechanical ventilation, platelet transfusion, bronchoscopy, TIPS, sepsis,
and never received CPR were independent predictors of increased TCPC (p < 0.001).
Simple prognostic models for mortality and resource utilization have been developed
for cirrhotic patients admitted to the MICU.