Intensive care of the patient with cirrhosis.Olson JC, Wendon JA, Kramer DJ, Arroyo V, Jalan R, Garcia-Tsao G, Kamath PS. Hepatology. 2011 Aug 24. [Epub ahead of print] Acute deterioration of patients with cirrhosis manifests as multiple organ failure requiring admission to an intensive care unit.
Precipitating events may be viral hepatitis in some parts of the world; and drug or alcoholic hepatitis, and variceal hemorrhage in the West. Patients with cirrhosis in the intensive care unit have a high mortality and each admission is associated with a mean charge of $116,200. Prognosis is determined by the number of organs failing (SOFA score), the presence of infection, and the degree of liver dysfunction (CTP or MELD scores). The most common organ failing is the kidney; sepsis is associated with further deterioration in liver function by compromise of the microcirculation. Care of these critically ill patients with impending multiple-organ failure requires a team approach of clinicians with expertise in both hepatology and critical care. Treatment is aimed at preventing further deterioration in liver function, reversing precipitating factors, and supporting failing organs. Liver transplantation is required in selected patients to improve survival and quality of life. In some patients treatment is futile, but it is difficult to identify these patients a priori. Artificial and bioartificial liver support systems have thus far not demonstrated significant benefit in the management of these patients. leggi l’articolo