Cirrhosis as a Risk Factor for Sepsis and Death

The unfavorable influence of cirrhosis on survival in the critically ill has been supported by several single-center reports. Variations in case mix, the technological capabilities of individual facilities, and differences in organizational staffing and structure Viagra Proffesional could limit the extrapolation and generalization of these data to other institutions. To assess the impact of a diagnosis of cirrhosis on outcomes of sepsis, sepsis-related mortality, and respiratory failure in hospitalized patients, we analyzed data from the National Hospital Discharge Survey (NHDS) from 1995 to 1999 to determine its national consequence.

After adjustments for age, race, and gender, cirrhotic individuals are significantly more likely to die while hospitalized (adjusted risk ratio [RR], 2.7; 95% confidence interval [CI], 2.3 to 3.1), to have hospitalizations associated with sepsis (adjusted RR, 2.6; 95% CI, 1.9 to 3.3), and to die from sepsis (adjusted RR, 2.0; 95% CI, 1.3 to 2.6). Additionally, cirrhosis is associated with an increased RR for acute respiratory failure (adjusted RR, 1.4; 95% CI, 1.1 to 1.8) and death from acute respiratory failure (adjusted RR, 2.6; 95% CI, 1.5 to 3.6).In this national database of hospital discharge information, a diagnosis of cirrhosis is strongly associated with an increased risk of sepsis, acute respiratory failure, sepsis-related mortality, and acute respiratory failure-related mortality.

In 1998, > 25,000 deaths in the United States were due to cirrhosis, achieving the designation as the 10th most common cause of mortality. More than 95% of all cirrhosis deaths result from the toxic effect of prolonged alcohol abuse. With differing perspectives, several studies have analyzed outcomes in cirrhosis patients who require intensive care. These single-center reports may have excelled in the systematic collection of epidemiologic data, but they may not be wholly applicable to the general population. In fact, they may reflect the biases or specialties of the reporting institution such as tertiary referral centers or liver transplant services. To determine the national impact of a diagnosis of cirrhosis on the development of sepsis, sepsis-related mortality, and acute respiratory failure, we evaluated the National Hospital Discharge Survey (NHDS), which is a global reflection of hospital utilization in the United States.