Predictors of Respiratory Failure Development in a Multicenter Cohort of Inpatients With Cirrhosis
Copyright © 2023 by The American College of Gastroenterology..
INTRODUCTION: Hospitalized patients with cirrhosis can develop respiratory failure (RF), which is associated with a poor prognosis, but predisposing factors are unclear.
METHODS: We prospectively enrolled a multicenter North American cirrhosis inpatient cohort and collected admission and in-hospital data (grading per European Association for the Study of Liver-Chronic Liver Failure scoring system, acute kidney injury [AKI], infections [admission/nosocomial], and albumin use) in an era when terlipressin was not available in North America. Multivariable regression to predict RF was performed using only admission day and in-hospital events occurring before RF.
RESULTS: A total of 511 patients from 14 sites (median age 57 years, admission model for end-stage liver disease [MELD]-Na 23) were enrolled: RF developed in 15%; AKI occurred in 24%; and 11% developed nosocomial infections (NI). At admission, patients who developed RF had higher MELD-Na, gastrointestinal (GI) bleeding/AKI-related admission, and prior infections/ascites. During hospitalization, RF developers had higher NI (especially respiratory), albumin use, and other organ failures. RF was higher in patients receiving albumin (83% vs 59%, P < 0.0001) with increasing doses (269.5 ± 210.5 vs 208.6 ± 186.1 g, P = 0.01) regardless of indication. Admission for AKI, GI bleeding, and high MELD-Na predicted RF. Using all variables, NI (odds ratio [OR] = 4.02, P = 0.0004), GI bleeding (OR = 3.1, P = 0.002), albumin use (OR = 2.93, P = 0.01), AKI (OR = 3.26, P = 0.008), and circulatory failure (OR = 3.73, P = 0.002) were associated with RF risk.
DISCUSSION: In a multicenter inpatient cirrhosis study of patients not exposed to terlipressin, 15% of patients developed RF. RF risk was highest in those admitted with AKI, those who had GI bleeding on admission, and those who developed NI and other organ failures or received albumin during their hospital course. Careful volume monitoring and preventing nosocomial respiratory infections and renal or circulatory failures could reduce this risk.
| Medienart: |
E-Artikel |
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| Erscheinungsjahr: |
2024 |
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| Erschienen: |
2024 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:119 |
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| Enthalten in: |
The American journal of gastroenterology - 119(2024), 4 vom: 01. Apr., Seite 712-718 |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
Bajaj, Jasmohan S [VerfasserIn] |
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| Anmerkungen: |
Date Completed 08.04.2024 Date Revised 08.04.2024 published: Print-Electronic Citation Status MEDLINE |
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| doi: |
10.14309/ajg.0000000000002574 |
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| funding: |
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| Förderinstitution / Projekttitel: |
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NLM364299142 |
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| 100 | 1 | |a Bajaj, Jasmohan S |e verfasserin |4 aut | |
| 245 | 1 | 0 | |a Predictors of Respiratory Failure Development in a Multicenter Cohort of Inpatients With Cirrhosis |
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| 500 | |a Date Revised 08.04.2024 | ||
| 500 | |a published: Print-Electronic | ||
| 500 | |a Citation Status MEDLINE | ||
| 520 | |a Copyright © 2023 by The American College of Gastroenterology. | ||
| 520 | |a INTRODUCTION: Hospitalized patients with cirrhosis can develop respiratory failure (RF), which is associated with a poor prognosis, but predisposing factors are unclear | ||
| 520 | |a METHODS: We prospectively enrolled a multicenter North American cirrhosis inpatient cohort and collected admission and in-hospital data (grading per European Association for the Study of Liver-Chronic Liver Failure scoring system, acute kidney injury [AKI], infections [admission/nosocomial], and albumin use) in an era when terlipressin was not available in North America. Multivariable regression to predict RF was performed using only admission day and in-hospital events occurring before RF | ||
| 520 | |a RESULTS: A total of 511 patients from 14 sites (median age 57 years, admission model for end-stage liver disease [MELD]-Na 23) were enrolled: RF developed in 15%; AKI occurred in 24%; and 11% developed nosocomial infections (NI). At admission, patients who developed RF had higher MELD-Na, gastrointestinal (GI) bleeding/AKI-related admission, and prior infections/ascites. During hospitalization, RF developers had higher NI (especially respiratory), albumin use, and other organ failures. RF was higher in patients receiving albumin (83% vs 59%, P < 0.0001) with increasing doses (269.5 ± 210.5 vs 208.6 ± 186.1 g, P = 0.01) regardless of indication. Admission for AKI, GI bleeding, and high MELD-Na predicted RF. Using all variables, NI (odds ratio [OR] = 4.02, P = 0.0004), GI bleeding (OR = 3.1, P = 0.002), albumin use (OR = 2.93, P = 0.01), AKI (OR = 3.26, P = 0.008), and circulatory failure (OR = 3.73, P = 0.002) were associated with RF risk | ||
| 520 | |a DISCUSSION: In a multicenter inpatient cirrhosis study of patients not exposed to terlipressin, 15% of patients developed RF. RF risk was highest in those admitted with AKI, those who had GI bleeding on admission, and those who developed NI and other organ failures or received albumin during their hospital course. Careful volume monitoring and preventing nosocomial respiratory infections and renal or circulatory failures could reduce this risk | ||
| 650 | 4 | |a Multicenter Study | |
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| 650 | 7 | |a Albumins |2 NLM | |
| 700 | 1 | |a Kamath, Patrick S |e verfasserin |4 aut | |
| 700 | 1 | |a Reddy, K Rajender |e verfasserin |4 aut | |
| 700 | 1 | |a Asrani, Sumeet K |e verfasserin |4 aut | |
| 700 | 1 | |a Keaveny, Andrew P |e verfasserin |4 aut | |
| 700 | 1 | |a Tandon, Puneeta |e verfasserin |4 aut | |
| 700 | 1 | |a Duarte-Rojo, Andres |e verfasserin |4 aut | |
| 700 | 1 | |a Kappus, Matthew |e verfasserin |4 aut | |
| 700 | 1 | |a Verna, Elizabeth |e verfasserin |4 aut | |
| 700 | 1 | |a Biggins, Scott W |e verfasserin |4 aut | |
| 700 | 1 | |a Vargas, Hugo E |e verfasserin |4 aut | |
| 700 | 1 | |a Albhaisi, Somaya |e verfasserin |4 aut | |
| 700 | 1 | |a Shaw, Jawaid |e verfasserin |4 aut | |
| 700 | 1 | |a Dahiya, Monica |e verfasserin |4 aut | |
| 700 | 1 | |a Filipek, Natalia |e verfasserin |4 aut | |
| 700 | 1 | |a Fallahzadeh, Mohammad Amin |e verfasserin |4 aut | |
| 700 | 1 | |a Wegermann, Kara |e verfasserin |4 aut | |
| 700 | 1 | |a Cabello, Ricardo |e verfasserin |4 aut | |
| 700 | 1 | |a Bera, Chinmay |e verfasserin |4 aut | |
| 700 | 1 | |a Thuluvath, Paul |e verfasserin |4 aut | |
| 700 | 1 | |a Bush, Brian |e verfasserin |4 aut | |
| 700 | 1 | |a Thacker, Leroy R |e verfasserin |4 aut | |
| 700 | 1 | |a Wong, Florence |e verfasserin |4 aut | |
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