Systematic Reviews
Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Aug 7, 2015; 21(29): 8964-8973
Published online Aug 7, 2015. doi: 10.3748/wjg.v21.i29.8964
Allocation of patients with liver cirrhosis and organ failure to intensive care: Systematic review and a proposal for clinical practice
Katrine Prier Lindvig, Ane Søgaard Teisner, Jens Kjeldsen, Thomas Strøm, Palle Toft, Valentin Furhmann, Aleksander Krag
Katrine Prier Lindvig, Ane Søgaard Teisner, Jens Kjeldsen, Aleksander Krag, Department of Gastroenterology and Hepatology, Odense University Hospital, 5000 Odense, Denmark
Thomas Strøm, Palle Toft, Department of Anestesiology and Intensive Care, Odense University Hospital, 5000 Odense, Denmark
Valentin Furhmann, Department of Intensive Care Medicine, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany
Conflict-of-interest statement: The authors declare that they have no competing interests.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Katrine Prier Lindvig, Department of Gastroenterology and Hepatology, Odense University Hospital, Sdr. Boulevard 29, 5000 Odense, Denmark. kalin09@student.sdu.dk
Telephone: +76-63-1000
Received: February 7, 2015
Peer-review started: February 10, 2015
First decision: March 28, 2015
Revised: April 11, 2015
Accepted: June 16, 2015
Article in press: June 16, 2015
Published online: August 7, 2015
Abstract

AIM: To propose an allocation system of patients with liver cirrhosis to intensive care unit (ICU), and developed a decision tool for clinical practice.

METHODS: A systematic review of the literature was performed in PubMed, MEDLINE and EMBASE databases. The search includes studies on hospitalized patients with cirrhosis and organ failure, or acute on chronic liver failure and/or intensive care therapy.

RESULTS: The initial search identified 660 potentially relevant articles. Ultimately, five articles were selected; two cohort studies and three reviews were found eligible. The literature on this topic is scarce and no studies specifically address allocation of patients with liver cirrhosis to ICU. Throughout the literature, there is consensus that selection criteria for ICU admission should be developed and validated for this group of patients and multidisciplinary approach is mandatory. Based on current available data we developed an algorithm, to determine if a patient is candidate to intensive care if needed, based on three scoring systems: premorbid Child-Pugh Score, Model of End stage Liver Disease score and the liver specific Sequential Organ Failure Assessment score.

CONCLUSION: There are no established systems for allocation of patients with liver cirrhosis to the ICU and no evidence-based recommendations can be made.

Keywords: Cirrhosis, Failure, Intensive care, Allocation, Treatment

Core tip: The literature regarding allocation of cirrhotic patients to intensive care unit (ICU) is very limited and no studies have proposed and tested any specific allocation criteria. Thus it still remains to be determined, which cirrhotic patients will benefit from intensive care treatment, and if so, when during admission they should be transferred to the ICU, and when intensive treatment is futile and should be withheld. We propose an allocation system for clinical practice, based on internationally validated scoring systems.