Fichet et al identified prognostic factors for a patient in the intensive care unit (ICU) with severe hepatic encephalopathy. The authors are from Centre Hospitalier Universitaire de Tours and Universite Francois Rabelais in Tours, France.


Patient selection: severe hepatic encephalopathy (median Child-Pugh score 11+/- 2, with 76% admitted to the ICU in coma)


Predictors of ICU and 1-year mortalities based on multivariate analysis:

(1) vasopressors use (indicative of severe hypotension; odds ratio 7.7 for ICU mortality, 11.3 for 1 year mortality)

(2) acute renal failure or the hepatorenal syndrome (odds ratio 7.3 for ICU mortality and 5.3 for 1 year mortality)

(3) SAPS II score (odds ratio 1.03 for ICU mortality and 1.07 for 1 year mortality per point; the median SAPS II score was 56 which would be associated with an odds ratio for ICU mortality of 1.03^56 = 5.2)


Respiratory failure with the need for mechanical ventilation was identified as a risk factor on univariate but not on multivariate analysis.


These findings may also be viewed in terms of the number of organ failures. with the person starting from a baseline of 2 (hepatic and neurologic failures).


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