Abstract In 2010, cirrhosis was the eighth leading cause of death in the US, accounting for approximately 50,000 deaths. Liver transplant centers such as Saint Louis University Hospital(SLUH) frequently receive transfer requests for patients with decompensated liver cirrhosis from regional hospitals. However, decompensation is associated with substantial morbidity and mortality, and many patients do not survive long enough to undergo liver transplantation. Furthermore, comorbidities unrelated to liver disease often make these patients poor transplant candidates. Such transfers may impose additional financial and emotional burdens and sometimes provide families with unrealistic expectations of transplant eligibility. A prior study has shown that only 13% of patients with decompensated cirrhosis are evaluated or listed for liver transplantation, and only 3% ultimately receive a liver transplant. The objective of this study was to identify clinical factors associated with in-hospital mortality among patients transferred for decompensated cirrhosis, with the goal of guiding ICU transfer and transplant referral decisions. We hypothesized that greater liver disease severity, higher levels of critical illness, and multi-organ dysfunction would be associated with increased in-hospital mortality and lower chance of liver transplant. We conducted a retrospective cohort study of patients aged 18-89 years transferred to SLUH for decompensated liver cirrhosis between June 31, 2021, and July 1, 2023. Demographic, clinical, and laboratory variables were collected, including MELD-Na score, hepatic encephalopathy, GI bleeding, WBC count, lactic acid, acute kidney injury (AKI), chronic kidney disease (CKD), continuous renal replacement therapy (CRRT), sepsis, shock, mechanical ventilation, and APACHE II score. Continuous variables were summarized as mean ± standard deviation, and categorical variables as frequency and percentage. Between-group comparisons used two-sample t-tests or Wilcoxon rank-sum tests for continuous variables and Chi-square tests for categorical variables. Logistic regression adjusted for MELD-Na was used to identify independent predictors of mortality. Seventy-eight patients were included. The overall in-hospital mortality rate was 66.7%, with an average ICU stay of 8.6 days. Four patients (5.1%) underwent liver transplantation. Higher MELD-Na, elevated WBC, lactic acid, AKI, CRRT use, shock, sepsis, mechanical ventilation, hepatic encephalopathy, and GI bleeding were associated with mortality. After MELD-Na adjustment, shock remained independently associated with death. Mortality did not differ by cirrhosis etiology. Critically ill patients with decompensated cirrhosis and hemodynamic instability have markedly high mortality regardless of liver disease severity. A comprehensive assessment of systemic illness should guide ICU transfer and transplant decisions. Larger multicenter studies are warranted to validate these findings. This abstract is funded by: none
Lin et al. (Fri,) studied this question.