(450) Reason for Admission as a Predictor of Outcomes in a Liver Disease-Specific Intensive Care Unit

Introduction: The Medical Intensive Liver Unit (MILU) is a specialized Intensive Care Unit (ICU) established in 2018 aiming to address the complex needs of patients with advanced liver disease, such as acute-on-chronic liver failure, acute liver failure, and decompensated cirrhosis, through a multidisciplinary approach. We aimed to examine associations between initial reason for admission (RFA) and outcomes.

Methods: We conducted retrospective analyses on patients admitted to the MILU between 2018-2023 (n=1192). Data were obtained from electronic medical records and included demographic, RFA, length of stay (LOS), and LT status. RFA stratification included acute liver failure (ALF), acute respiratory failure (ARF), acute kidney injury (AKI), altered mental status (AMS), gastrointestinal bleeding (GIB), shock, and other RFAs. Statistical analyses were performed using the Kruskal-Wallis test, X2, Fisher’s exact test, and logistic regression, while adjusting for age, gender, and race.

Results: The mean age was 54.0 (±13.6) years, and the majority were female (51.3%). The most frequent RFA was GIB (25.1%), shock (23.2%), AMS (14.9%), AKI (12.5%), ALF (9.7%), and ARF (9.6%). AKI patients were older (58.13±11.38, p< 0.0001), ARF patients were more likely to be female (60.9%, p=0.001), and ALF patients were more likely to be White (36.2%, p=0.0005). ARF patients had longer LOS (9.84±10.7 days, p< 0.0001) and were more likely to be intubated (68.7%, p=0.0005). Patients with AKI were more likely to be evaluated for (36.9%), p=0.0005) and undergo (52.4%, p=0.0005) liver transplant (LT). In adjusted multivariate modeling, AKI (OR:2.28, 95%CI:1.15, 4.79) was positively associated with LT, while ALF (OR: 0.29, 95%CI: 0.11, 0.72) was negatively associated with LT.

Conclusions: These findings indicate significant variations in demographics, clinical characteristics, and outcomes based on the RFA. Early multidisciplinary interventions enable the creation of individualized care plans for critically ill liver patients to manage both their RFA and later complications, optimizing them for LT or recovery. This study emphasizes the role of liver disease-specific intensive care for this vulnerable population.