(250) Prevalence and Impact on Outcomes of Cirrhotic Cardiomyopathy in a Cohort of Critically Ill Patients

Tuesday, February 25, 2025

12:30pm – 1:30pm Eastern Time

Location: Connections Central - RST 04

First Author(s)

Shah N. Mahmud, DO

Woburn, Massachusetts, USA

Co-Author(s)

MW

Mark Wadid, MD

Internal Medicine Resident Physician
Lahey Hospital and Medical Center, United States
CL

Candace Lessey, MD

Internal Medicine Resident Physician
Lahey Hospital and Medical Center, United States
ME

Maisa Elbadawi, MD

Internal Medicine Resident Physician
Lahey Hospital and Medical Center, United States
AP

Avignat Patel, MD

Pulmonary and Critical Care Attending Physician
Lahey Hospital and Medical Center Burlington
Burlington, Massachusetts, United States

Introduction: Cirrhotic cardiomyopathy (CCM) is characterized by cardiac dysfunction in cirrhotic patients without known cardiac disease. CCM manifests as impaired cardiac response to physiologic and hemodynamic stressors. In this study, we aimed to investigate the prevalence of CCM in critically ill patients, and its association with mortality, shock and other comorbidities.

Methods: We performed an IRB-approved retrospective cohort study of patients with cirrhosis admitted to the ICU at Lahey Hospital & Medical Center over a 1-year period. CCM was defined per the 2019 Cirrhotic Cardiomyopathy Consortium as systolic dysfunction (LVEF ≤ 50%) or diastolic dysfunction (≥ 3 of the following: septal e’ velocity < 7 cm/s, E/e’ ratio ≥15, left atrial volume index >34 mL/m2, TR velocity >2.8 m/s). We parameterized admitting TTEs to ≤ 3 years prior to ICU admission. We employed summary statistics for CCM prevalence and incidence of outcomes of interest.

Results: The cohort was composed of 167 individuals. In the overall cohort, mean age was 56.6 +/- 12.4 years, 66% were male, alcohol was most common cirrhosis etiology (56.9%), GI bleeding was most common ICU admitting diagnosis (31.7%), and mean MELD-Na score was 27 +/-1.02. The prevalence of acute kidney injury (AKI) was 54.5%, of coronary artery disease was 7.2%, and of atrial fibrillation was 13.8%. 37.1% of the cohort had pre-admission TTEs and 9.7% of this sub-group met CCM criteria. Amongst those with CCM, ICU mortality was 16.7%, 80% had AKI with 33.3% requiring renal replacement therapy (RRT), 50% required invasive mechanical ventilation (average duration 6.3 ± 11.5 days), and 50% had shock. Amongst those without CCM, ICU mortality was 53.6%, 60.4% had AKI with 27.8% requiring RRT, 58.1% required invasive mechanical ventilation (average duration 3.8 ± 5.3 days), and 62.5% had shock.

Conclusions: The prevalence of CCM in our cohort was lower than in other reports, however the analysis was limited by lack of TTEs in many individuals. The low prevalence precluded any conclusion on mortality in critically ill patients with CCM. Although those with CCM had higher incidence of AKI and longer duration of mechanical ventilation, these did not reach statistical significance. Future research into the impact of CCM on outcomes in critically ill patients is needed.