Intensive Care of Patients with End-Stage Liver Disease (MELD > 30)

Intensive Care of Patients with End-Stage Liver Disease (MELD > 30) Background: Acute deterioration of the state of health of patients with cirrhosis manifests as multiple organ failure requiring admission to an intensive care unit. Precipitating events may be viral hepatitis, drug or alcoholic hepatitis, infections, and variceal hemorrhage. Method: Literature review. Results: Patients with cirrhosis in the intensive care unit have a high mortality. Prognosis is determined by the number of organs failing, the presence of infection, and the degree of liver dysfunction. The most common organ failure occurs in the kidney, and sepsis is associated with further deterioration in liver function. Care of these critically ill patients with multiple organ failure requires a team approach with expertise in both hepatology and intensive care. Treatment is aimed at preventing further deterioration in liver function, reversing precipitating factors, and supporting failing organs. Liver transplantation is required for selected patients in order to improve survival and quality of life. Extracorporeal liver support systems have thus far not demonstrated a significant survival benefit in these patients. Conclusions: Intensive care of patients with end-stage liver disease remains challenging and is futile in some cases. However, a trial of unrestricted intensive care could be proposed for selected critically ill cirrhotic patients. If the organ failure cannot at least be partly contained within a couple of days, the prognosis is unfavorable.