The following is a summary of “Outcomes and time trends of acute respiratory distress syndrome patients with and without liver cirrhosis: an observational cohort,” published in the September 2023 issue of Critical Care by Pensier et al.

Liver cirrhosis in acute respiratory distress syndrome (ARDS) was associated with high mortality rates before lung-protective ventilation, but its outcome with lung-protective ventilation is unclear. Researchers conducted a retrospective study to assess the association between cirrhosis and mortality in ARDS and trends in mortality and severity over time.

They conducted an analysis in a 20-bed tertiary ICU (October 2003 to December 2021). All consecutive adults were enrolled critically ill patients diagnosed with ARDS using the Berlin criteria. The primary outcome, 90-day mortality, was assessed using Kaplan-Meier curves and multivariate Cox analysis. Also, time trends in 90-day mortality, Sequential Organ-Function Assessment score (SOFA), and non-hepatic SOFA were analyzed. Ventilation settings were compared between patients with and without cirrhosis.

The results showed 7,155 screened patients, 863 were diagnosed with ARDS, and 157 (18%) had cirrhosis. The overall 90-day mortality rate was 43% (378/863), with 57% (90/157) in cirrhosis patients and 41% (288/706) in non-cirrhosis patients (P<0.001). Cirrhosis was associated with 90-day mortality on survival curves (P<0.001) and independently in multivariate analysis (hazard ratio = 1.56, 95% CI: 1.20–2.02). Mortality remained stable over time in both ARDS patients with and without cirrhosis. SOFA (P=0.04) and non-hepatic SOFA (P=0.02) increased over time in ARDS patients without cirrhosis but remained stable in those with cirrhosis. Tidal volume, positive end-expiratory pressure, plateau pressure, and driving force were similar in ARDS patients with and without cirrhosis.

They concluded that despite improvements in ARDS management, 90-day mortality remained high and stable for patients with cirrhosis (57%) and without cirrhosis (41%).

Source: annalsofintensivecare.springeropen.com/articles/10.1186/s13613-023-01190-1