The Survival of Septic Patients with Compensated Liver Cirrhosis Is Not Inferior to That of Septic Patients without Liver Cirrhosis: A Propensity Score Matching Analysis

Ya-Chun Chang; Ying-Tang Fang; Hung-Cheng Chen; Chiung-Yu Lin; Yu-Ping Chang; Yi-Hsuan Tsai; Yu-Mu Chen; Kuo-Tung Huang; Huang-Chih Chang; Chin-Chou Wang; Meng-Chih Lin; Wen-Feng Fang

doi:10.3390/jcm11061629

The Survival of Septic Patients with Compensated Liver Cirrhosis Is Not Inferior to That of Septic Patients without Liver Cirrhosis: A Propensity Score Matching Analysis

J Clin Med. 2022 Mar 15;11(6):1629. doi: 10.3390/jcm11061629.

Authors

Ya-Chun Chang^{1

2}, Ying-Tang Fang¹, Hung-Cheng Chen¹, Chiung-Yu Lin¹, Yu-Ping Chang¹, Yi-Hsuan Tsai¹, Yu-Mu Chen¹, Kuo-Tung Huang¹, Huang-Chih Chang¹, Chin-Chou Wang^{1

3

4}, Meng-Chih Lin^{1

3}, Wen-Feng Fang^{1

3

4}

Affiliations

¹ Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung 833, Taiwan.
² Department of Internal Medicine, Kaohsiung Municipal Min-Sheng Hospital, Kaohsiung 802, Taiwan.
³ Department of Respiratory Therapy, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung 833, Taiwan.
⁴ Department of Respiratory Care, Chang Gung University of Science and Technology, Chiayi 613, Taiwan.

Abstract

Background: We aimed to determine whether septic patients with liver cirrhosis (LC) had worse survival than septic patients without liver cirrhosis (WLC). We also investigated the survival of septic patients with compensated liver cirrhosis (CLC) and decompensated liver cirrhosis (DLC). Methods: This study enrolled 776 consecutive adult patients with sepsis admitted to the medical intensive care units of a tertiary referral hospital. Clinical factors and laboratory data were collected for analysis. Propensity scoring was also used for the control of selection bias. The variables included in the propensity model were age, sex, presence of diabetes mellitus, hypertension, cardiovascular accident, chronic kidney disease, malignancy, APCHE II (Acute Physiology and Chronic Health Evaluation) score, hemoglobin, and platelet data on the day when sepsis was confirmed. Seven-day, ICU, and hospital mortality were analyzed after correcting for these confounding factors. Results: Of the 776 septic patients, 64 (8.2%) septic patients presented with LC. Patients were divided into two groups—LC (n = 64) and WLC (n = 712)—which presented different rates of hospital mortality (LC: 62.5% vs. WLC: 41.0%, p = 0.001). We further separated septic patients with LC into two groups: patients with CLC (n = 24) and those with DLC (n = 40). After propensity score matching, the survival of septic patients with CLC (63.6%) was not inferior to patients WLC (54.5%) (p = 0.411). Patients with DLC had more hospital mortality, even after matching (p < 0.05). The Quick SOFA (qSOFA) score, SOFA score, and sub-SOFA score were also comparable between groups. SOFA scores were not significantly different between the CLC and WLC groups after matching. Poor SOFA scores were observed in the DLC group on days 3 and 7 after matching (p < 0.05). Conclusions: Septic patients with LC had higher mortality compared to patients WLC before matching. However, after propensity score matching, the survival of septic patients with CLC was non-inferior to patients WLC.

Keywords: intensive care; liver cirrhosis; propensity score; sepsis.

Abstract

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