Korean J Intern Med.  2016 Mar;31(2):288-295. 10.3904/kjim.2014.152.

Bleeding complications in critically ill patients with liver cirrhosis

• Cho J
• Choi SM
• Yu SJ
• Park YS
• Lee CH
• Lee SM
• Yim JJ
• Yoo CG
• Kim YW
• Han SK
• Lee J

• KMID: 2373804
• DOI: http://doi.org/10.3904/kjim.2014.152

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.

Keyword

Liver cirrhosis; Intensive care unit; Hemorrhage; Risk factors

MeSH Terms

Aged
Blood Platelets
Critical Illness
Female
Gastrointestinal Hemorrhage/blood/diagnosis/*etiology/mortality
Hospital Mortality
Humans
Intensive Care Units
Liver Cirrhosis/blood/*complications/diagnosis/mortality
Male
Middle Aged
Multivariate Analysis
Odds Ratio
Platelet Count
Prognosis
Republic of Korea
Respiratory Tract Diseases/blood/diagnosis/*etiology/mortality
Retrospective Studies
Risk Factors
Sepsis/blood/complications
Time Factors