Patients undergoing invasive mechanical ventilation (IMV) who have a history of liver cirrhosis have a higher risk for mortality than the general population, according to study results presented at the American College of Chest Physicians (CHEST) 2022 Annual Meeting, held from October 16 to 19, 2022, in Nashville, Tennessee.
Study authors sought to assess how a history of liver cirrhosis affected patients undergoing IMV with respect to mortality, long-term ventilator dependence, and health care resources. The primary outcome was mortality difference; secondary outcomes were the risk for prolonged IMV, tracheostomy, palliative care, length of stay, and resource use. Results were adjusted for age, sex, race, Charlson Comorbidity Index score, hospital type and region, and teaching status.
The study included 3,021,785 patients in the National Inpatient Sample (NIS) database who had undergone invasive mechanical ventilation from 2016 to 2019. Of those, 69,784 (2.3%) had a history of cirrhosis. The cohort had a mean age of 55.4 years, 55% were men, the mean length of hospital stay was 14 days, and the mean charge of care was $212,585.
Compared with the general population, patients receiving IMV who had a history of cirrhosis had a significantly increased adjusted odds ratio (OR) for mortality (OR 1.51; P <.001; 95% CI, 1.45-1.56) and increased odds of palliative encounters (OR 1.26; P <.001; 95% CI, 1.20-1.32).
Notably, investigators also found that within the study cohort, patients with a history of cirrhosis had lower odds of receiving prolonged IMV (OR 0.71; P <.001; 95% CI, 0.65-0.79) and tracheostomy (OR 0.55; P <.001; 95% CI, 0.47-0.63), and had a significantly decreased length of stay (coefficient -2.37; P <.001; 95% CI, -2.60 to -2.13) and cost of care (coefficient -$24,554; P <.001; 95% CI, -$30,351 to -$18,757) compared with patients without a history of cirrhosis receiving IMV.
Study authors recommended that clinicians anticipate “worse outcomes in cirrhosis patients undergoing mechanical ventilation, mandating appropriate palliative care and discussion of code status in this high-risk group prior to placing them on mechanical ventilation, if possible.”
Aldiabat M, Yusuf M, Al-Khateeb M, et al. Studying the impact of liver cirrhosis on patients undergoing invasive mechanical ventilation: a nationwide analysis of 3 million patients. Abstract presented at: CHEST 2022 Annual Meeting; October 16-19, 2022; Nashville, TN.