Predictors of Respiratory Failure Development in A Multi-Center Cohort of Inpatients with Cirrhosis.

Abstract

OBJECTIVES:

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 multi-center North American cirrhosis inpatient cohort and collected admission and in-hospital data [grading per EASL-CLIF scoring system, acute kidney injury (AKI), infections (admission/nosocomial) and albumin use] in an era when terlipressin was not available in North America. Multi-variable regression to predict RF was performed using only admission day, and in-hospital events occurring prior to RF.

RESULTS:

511 patients from 14 sites (median 57 years, admission 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, 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 gm,p=0.01) regardless of indication.

MULTIVARIABLE ANALYSIS:

Admission for AKI, GI bleeding and high MELD-Na predicted RF. Using all variables, NI (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.

CONCLUSIONS:

In a multi-center inpatient cirrhosis study of patients not exposed to terlipressin, 15% patients developed RF. RF risk was highest in those admitted with AKI, had GI bleeding on admission and those who developed nosocomial infections, and other organ failures, or received albumin during their hospital course. Careful volume monitoring and preventing nosocomial respiratory infections, renal or circulatory failures could reduce this risk.

• Authors: Jasmohan S Bajaj, Patrick S Kamath, K Rajender Reddy, Sumeet K Asrani, Andrew P Keaveny, Puneeta Tandon, Andres Duarte-Rojo, Matthew Kappus, Elizabeth Verna, Scott W Biggins, Hugo E Vargas, Somaya Albhaisi, Jawaid Shaw, Monica Dahiya, Natalia Filipek, Mohammad Amin Fallahzadeh, Kara Wegermann, Ricardo Cabello, Chinmay Bera, Paul Thuluvath, Brian Bush, Leroy R Thacker, Florence Wong
• Journal: The American journal of gastroenterology (Am J Gastroenterol) (Nov 08 2023) ISSN: 1572-0241 [Electronic] United States
• PMID: 37938163 (Publication Type: Journal Article)
• Copyright: Copyright © 2023 by The American College of Gastroenterology.