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Factors associated with outcome in acute liver failure in an intensive care unit.
MedLine Citation:
PMID:  23054946     Owner:  NLM     Status:  Publisher    
Abstract/OtherAbstract:
AIM: To study the factors associated with outcome in acute liver failure (ALF) in an intensive care unit (ICU). METHODS: Consecutive patients with ALF admitted to the ICU from August 2003 to April 2010 were included. Factors associated with the primary outcome, death or survival, were compared. RESULTS: Of 52 patients of median age 19 years (range 3-65), 35 (67 %) died. The etiology was viral hepatitis in 66 %, drug induced (anti-tubercular therapy) in 15 % and idiopathic in 15 %. Grades III+IV encephalopathy were found in 12 (70.6 %) survivors as against 33 (94.3 %) nonsurvivors (p = 0.019). The median admission sequential organ failure assessment (SOFA) score was eight in survivors vs. 12 in nonsurvivors (p < 0.001). Median admission prothrombin time (PT) was 42 s in survivors vs. 51 in nonsurvivors (p = 0.384); 16/17 (94.1 %) survivors had normal PT on day 4 as compared to 7/35 (20 %) nonsurvivors (p < 0.001). Median PT on day 4 was 18 s in survivors against 37 in nonsurvivors (p < 0.001). Serum bilirubin, alanine aminotransferase; and serum creatinine, sodium and phosphorus were similar in survivors and nonsurvivors. Mechanical ventilation, vasopressors and dialysis were used in 65 %, 30 %, and 12 % survivors as against 100 % (p < 0.001), 51 % and 26 % nonsurvivors. Sixteen patients had upper gastrointestinal (GI) bleed. Blood cultures were positive more often in nonsurvivors (p = 0.058). On multiple regression analysis, factors independently associated with outcome included admission SOFA score >9.5 and absolute value of PT on day 4. CONCLUSIONS: Grades III and IV encephalopathy, higher SOFA score at admission and a prolonged PT which did not normalize by 4 days were associated with mortality in ALF.
Authors:
Banani Poddar; Saurabh Saigal; Anand Kumar; Ratender K Singh; Afzal Azim; Mohan Gurjar; Arvind Baronia
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2012-10-11
Journal Detail:
Title:  Indian journal of gastroenterology : official journal of the Indian Society of Gastroenterology     Volume:  -     ISSN:  0975-0711     ISO Abbreviation:  Indian J Gastroenterol     Publication Date:  2012 Oct 
Date Detail:
Created Date:  2012-10-11     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  8409436     Medline TA:  Indian J Gastroenterol     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Affiliation:
Department of Critical Care Medicine, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, 226 014, India, bananip@gmail.com.
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