Which cirrhotic patient should be admitted in the intensive care unit?

Abstract

The decision to admit a patient with severely decompensated cirrhosis to a general intensive care unit (ICU) may be a difficult one, because of the high risk of death. Whatever is the reason for ICU admission (including gastrointestinal hemorrhage, encephalopathy, sepsis, and acute renal failure), immune system alterations and hemodynamic failure significantly increase the risk of multiorgan failure. Consistently, several studies showed that cirrhosis was an independent risk factor of mortality in ICU patients. Recent studies reported a 50% mortality rate of cirrhotic patients admitted in the ICU, which is higher than the 15 to 20% overall mortality rate attributed to ICU patients. The aims of this review were: 1) to determine the factors related to mortality risk in cirrhotic patients admitted in the ICU; 2) to analyze the performance of the various generalist and hepatic scores to predict mortality; and 3) to try to select which cirrhotic patients should or not be admitted in the ICU.