The attributable mortality of acute renal failure in critically ill patients with liver cirrhosis

Objective: To determine outcome and mortality risk related to acute renal failure (ARF) in critically ill patients with cirrhosis. Design and setting: A retrospective cohort analysis and two independent case-control analyses in a medical ICU. Patients: 41 and 32 patients who developed mild and severe ARF, respectively, matched (1:2 ratio) with cirrhotic patients without ARF during their ICU stay. Measurements and results: Cirrhotic patients with ARF had higher MELD, APACHE II, and SOFA scores at baseline that those without ARF. They had more respiratory failure and cardiovascular failure during ICU stay, longer stay in ICU, and a greater crude hospital mortality rate (65% vs. 32%). Multivariate survival analysis identified ARF (hazard ratio, HR, 4.1), alcohol abuse or dependency, and severe sepsis or septic shock as independent predictors of death. In case-control studies both mild and severe ARF were independently associated with mortality (HR, 2.6, and 4.2, respectively). Cirrhotic patients with mild ARF patients had a higher risk of death than those without ARF ( relative risk, RR, 2.0). Severe ARF was associated with an increase matched risk of death ( RR 2.6), higher mortality of 51%, and higher risk-adjusted mortality rate (2.1 vs. 0.9). Conclusions: ICU patients with liver cirrhosis still have a high crude mortality. In this specific population ARF is associated with an excess mortality, depending on the severity of renal dysfunction.