Cirrhosis as an independent predictor of poor outcomes in trauma patients was identified in 1990.
Dr Dale Dangleben and colleagues from Pennsylvania hypothesized that the degree of preinjury hepatic dysfunction is an independent predictor of mortality.
The researchers queried the trauma registry at their Level I trauma center for all ICD-9 codes for liver disease from 1999 to 2003.
Patients were categorized as having Child-Turcotte-Pugh class A, B, or C cirrhosis.
|40% met Child-Turcotte-Pugh A classification|
|Journal of the American College of Surgeons|
The research team analyzed age, mechanism of injury, Abbreviated Injury Score, Injury Severity Score, and Glasgow Coma Score.
The team also evaluated hospital length of stay, ventilator days, and procedures performed.
In addition, transfusion of blood products, admission lactate, base deficit, and mortality were assessed.
Trauma Related Injury Severity Score methodology was used to calculate the probability of survival.
The researchers analyzed outcomes data, and statistical comparison was performed using group t-test.
Of the 50 patients meeting study criteria, 31 had alcohol-related cirrhosis, 18 had a history of Hepatitis C, and 1 had cryptogenic cirrhosis.
The team reported that 40% met Child-Turcotte-Pugh A classification, 32% met Child-Turcotte-Pugh B criteria, and 28% had class C cirrhosis.
The team noted that 1 death occurred in the Child-Turcotte-Pugh A and B groups.
The 5 survivors and 9 nonsurvivors from Child-Turcotte-Pugh class C showed no significance in terms of age, Injury Severity-, Glasgow Coma-, or Trauma Related Injury Severity-Scores.
Dr Dangleben's team concludes, “Mortality rate for class C cirrhotic patients posttrauma continues to be higher than that predicted by Trauma Related Injury Severity Score.”
“However, 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 Child-Turcotte-Pugh C criteria must be considered when determining outcomes for patients posttrauma.”