Influence of Age on Critically Ill Patients with Cirrhosis

• Main Authors: Cheng-Yi Chen, Chih-Jen Wu, Chi-Feng Pan, Han-Hsiang Chen, Yu-Wei Chen
• Format: Article
• Language: English
• Published: Taiwan Society of Geriatric Emergency and Critical Medicine (TSGECM) 2015-12-01
• Series: International Journal of Gerontology
• Subjects: critical care; geriatric; intensive care unit; liver cirrhosis; old age
• Online Access: http://www.sciencedirect.com/science/article/pii/S1873959815001052

Background: The general prognosis of critically ill patients with cirrhosis is poor. We investigated the influence of age (< 65 years, 65–74 years, and ≥ 75 years) on the short- and medium-term outcomes of cirrhotic patients in the intensive-care-unit (ICU) setting. Methods: This retrospective cohort study included 226 consecutive patients with liver cirrhosis who were admitted to the ICU. Clinical outcomes, including ICU mortality, in-hospital mortality, ventilator-free days, ICU days, ICU-free days, hospital days, and hospital-free days, were compared between the different age groups. Results: The overall ICU mortality in patients aged < 65 years, 65–74 years, and ≥ 75 years was 29.4%, 20.0%, and 30.3%, respectively. For patients with compensated cirrhosis, age showed no significant correlation with mortality or clinical outcomes. For patients with decompensated cirrhosis, age ≥ 75 years was significantly correlated with in-hospital mortality, 6-month mortality, hospital days, and hospital-free days. After adjusting for sex, coronary artery disease, etiology of ICU admission, Acute Physiology and Chronic Health Evaluation II score, Model for End-Stage Liver Disease score, and mechanical ventilation, age ≥ 75 years remained significant for in-hospital mortality (hazard ratio 2.61, 95% confidence interval 1.27–5.39, p = 0.009) and 6-month mortality (hazard ratio 2.34, confidence interval 1.16–4.70, p = 0.017). Conclusion: During ICU stays, old age does not have adverse effects on ICU mortality, ventilator-free days, ICU days, or ICU-free days in cirrhotic patients (either compensated or decompensated cirrhosis). After ICU discharge, age ≥ 75 years is an independent prognostic factor for in-hospital mortality and 6-month mortality in patients with decompensated cirrhosis.