Chronic Hepatitis C Increases Risk of Death in Patients Admitted to ICU

BY LAUREN SANTYE, ASSISTANT EDITOR
HCV patients with cirrhosis and severe sepsis face elevated risk of organ failure.
PUBLISHED WEDNESDAY, APRIL 6, 2016
A study found that chronic hepatitis C (CHC) patients with cirrhosis and severe sepsis admitted to the ICU have an increased risk of death.

CHC affects approximately 9 million people in the European region and accounts for 350,000 deaths per year. For the study, researchers looked at data from the Spanish Minimum Basic Data Set (MBDS) and determined the patient’s length of stay. This was obtained as the difference in days between the date of hospital admission and date of discharge or death in the ICU.

Hospital admission was considered day zero, and those discharged on the same day were considered a 1-day stay. Those admitted more than once only had their first ICU admittance analyzed.

Patients selected for the analysis had both compensated and decompensated cirrhosis at the time of discharge. There were 4127 patients enrolled in the control group and 1138 in the CHC group.

The epidemiological and clinical characteristics of the 2 groups were similar, with the only clinically significant differences in the CHC group compared with the control group were a lower length of hospital stay (p < 0.001), less alcohol or drug abuse (p < 0.001), and a lower Charlson comorbidity index (p < 0.001).

Conversely, the CHC group exhibited a higher frequency of decompensated cirrhosis (p < 0.001). Severe sepsis in the CHC patient group and control group had similar cumulative incidence (37.9 vs. 36.6 %; p = 0.456). Within the 2 groups, the most common organ failure was respiratory failure and the most common site of infection was in the digestive tract.

Once severe sepsis in cirrhotic patients was categorized as compensated or decompensated, the CHC group with compensated cirrhosis had a cumulative incidence of severe sepsis compared with the control group at 37.4 vs. 31.1 %, respectively (p = 0.024). However, there were no differences found between the 2 groups with decompensated cirrhosis.

The CHC group had a higher ICU mortality rate compared with the control group at day 7 (47 vs 41.3 %; p = 0.001), 30 (78.5 vs. 73.5 %; p = 0.001), and 90 (85.4 vs. 82.8 %; p = 0.038). Once the groups were stratified for severe sepsis, the CHC group still had a higher mortality rate than the control group at day 7 (43.9 vs. 34 %; p < 0.001) and day 30 (87.5 vs. 79 %; p < 0.001).

Additionally, the CHC group with compensated cirrhosis had a higher rate of ICU mortality at day 7 (50.7 vs. 40.9 %; p = 0.001), 30 (77 vs. 68.5 %; p = 0.002), and 90 (81.4 vs. 75 %; p = 0.012). In the CHC group, there was a lower estimated ICU survival rate compared with the control group, especially in patients with severe sepsis.

The data revealed that the CHC group had a higher risk of death in the ICU if it was complicated by severe sepsis (aHR = 1.19; p = 0.003). There were no significant values found in patients with an absence of severe sepsis (aHR = 1.09; p = 0.068).

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