ASSESSING OUTCOME DISPARITIES AMONG CIRRHOTIC PATIENTS REQUIRING INVASIVE MECHANICAL VENTILATION FOR VARICEAL UPPER GASTROINTESTINAL BLEEDING: A CROSS-SECTIONAL STUDY

Abstract

Introduction: The global focus is on improving the quality of life for liver cirrhosis patients, particularly in low- and middle-income countries like Pakistan. It highlights the challenges in providing intensive care, including invasive mechanical ventilation, due to the increasing prevalence of liver cirrhosis. The study aims to examine outcomes for cirrhotic patients with upper GI bleeding requiring ICU care.

Methods: A cross-sectional study conducted in the Aga Khan University Hospital ICU in Karachi, Pakistan, from Jan to Nov 2016, focused on liver cirrhosis patients needing invasive mechanical ventilation. Data on patient characteristics, symptoms, hospitalization details, and outcomes, with exclusion criteria for specific conditions, were collected. Primary outcome was ICU mortality, wherease secondary outcome was differences in mortality based on various assessment scores. Statistical analysis was performed using SPSS, and significance was set at p<0.05.

Results: 88 patients were included  in the final analysis. The median age was 52 years, with 65.1% males and 34.1% females. 31.8% were intubated due to variceal bleeding, with a 50% mortality rate among them. Common diagnoses included hepatitis C, non-B and non-C hepatitis, and hepatitis B, with 79.5% requiring vasopressor support. Among the patients intubated due to excessive variceal bleeding, 50% died.

Conclusion: The study suggests cirrhosis patients needing invasive ventilation for upper GI bleeding fare better than those intubated for other reasons. Clinical parameters are crucial for prognosis. Multidisciplinary care is vital, involving hepatologists, intensivists, gastroenterologists, and critical care teams. Further research is needed to confirm findings and improve treatment strategies.