Original scientific article
Impact of Cirrhosis on Outcomes in Trauma

Abstract presented at the Pennsylvania ACS Committee on Trauma resident paper competition, Harrisburg, PA, October 29, 2004; and the Regional ACS Committee on Trauma resident paper competition, Washington, DC, December 4, 2004.
https://doi.org/10.1016/j.jamcollsurg.2006.08.001Get rights and content

Background

Cirrhosis as an independent predictor of poor outcomes in trauma patients was identified in 1990. We hypothesized that the degree of preinjury hepatic dysfunction is, by itself, an independent predictor of mortality.

Study design

The trauma registry at our Level I trauma center was queried for all ICD-9 codes for liver disease from 1999 to 2003, and patients were categorized as having Child-Turcotte-Pugh (CTP) class A, B, or C cirrhosis. Data analyzed included age, mechanism of injury, Abbreviated Injury Score (AIS), Injury Severity Score (ISS), Glasgow Coma Score (GCS), hospital length of stay, ventilator days, procedures performed, transfusion of blood products, admission lactate, base deficit, and mortality. Trauma Related Injury Severity Score (TRISS) methodology was used to calculate the probability of survival. Outcomes data were analyzed, and statistical comparison was performed using group t-test.

Results

Of the 50 patients meeting study criteria, 31 had alcohol-related cirrhosis, 18 had a history of hepatitis C, and 1 had cryptogenic cirrhosis. Twenty (40%) met CTP A classification, 16 (32%) met CTP B criteria, and 14 (28%) had CTP class C cirrhosis. One death occurred in the CTP A and B groups. Comparison between the five survivors and nine nonsurvivors from CTP class C showed no statistical significance in terms of age, ISS, TRISS, or GCS.

Conclusions

The mortality rate for class C cirrhotic patients posttrauma continues to be higher than that predicted by TRISS, although patients with less severe hepatic dysfunction do not appear to have significantly lower than predicted survival. The degree of hepatic dysfunction remains an independent predictor of mortality and CTP C criteria must be considered when determining outcomes for patients posttrauma.

Section snippets

Methods

This study protocol was carried out with the approval of our institutional review board. A review of registry data for all trauma patients admitted from January 1, 1999, through December 31, 2003, was performed. Patients were divided into those with preinjury liver disease, ie, International Classification of Diseases, 9th revision, (ICD-9) codes 571.2 and 571.5, and those without liver disease. The two groups were further characterized with respect to age, mechanism of injury, ISS, anatomic

Results

Fifty patients meeting study criteria for preexisting liver disease were identified during the outlined period. Thirty-one patients (62%) had cirrhosis related to alcohol use, 18 (36%) had cirrhosis related to history of hepatitis C, and 1 patient (2%) had cryptogenic cirrhosis. There were 20 (40%) patients meeting CTP class A criteria, 16 (32%) meeting CTP class B criteria, and 14 (28%) with CTP class C cirrhosis (Table 1). There were no statistically significant differences in age, TRISS,

Discussion

To date, this is the largest series reported in the literature focusing on trauma patients with preexisting cirrhosis. The mortality rate for CTP class C cirrhotic patients posttrauma continues to be higher than that predicted by TRISS. But patients with less severe hepatic dysfunction do not appear to have significantly lower than predicted survival. To the best of our knowledge, this is the first study to demonstrate that mortality posttrauma correlates independently with the degree of

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Competing Interests Declared: None.

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