Survival after severe liver failure requiring intensive care with and without liver transplantation: a 10-year retrospective study

Abstract

Introduction: Severe liver failure is treated in the intensive care unit (ICU) and carries a high mortality rate. Acute liver failure (ALF), without previous liver disease, and ´acute-on-chronic´ liver failure (ACLF), with previously known liver disease, are treated with aetiology-specific and supportive treatments. If the patient deteriorates in spite of medical treatment, transplantation may be lifesaving. Survival over time after intensive care is however not well studied in Sweden. Aim: This study aims to evaluate survival after severe liver failure requiring intensive care with and without transplantation, and regarding liver failure syndrome and sex, at the general intensive care unit at Sahlgrenska University Hospital, Gothenburg. Methods: A descriptive retrospective cohort study of patients diagnosed with liver failure treated in the general ICU ward 96 (CIVA) between January 1st, 2010 and September 7th, 2020 was implemented. Adults with ICD-10 diagnosis liver failure, K70-72, with mechanical ventilation and/or dialysis were included. Patients with previous or elective liver transplantation and metastatic cancer were excluded. Results: 168 patients--60 ALF and 108 ACLF--were included. Overall survival is higher in patients transplanted while in the ICU compared to not transplanted (p<0.001). ALF patients have a higher survival rate than ACLF patients (p=0.001). Both transplanted and non-transplanted ACLF patients have a low one-year survival rate: 65% and 20%, respectively. Conclusion: The high mortality of transplanted and non-transplanted ACLF patients point to the need to consider earlier examination of aetiology and evaluations for possible transplant in order to increase the overall survival of patients with severe liver failure.