Cirrhosis and trauma are a lethal combination

Chrysanthos Georgiou, Kenji Inaba, Pedro G R Teixeira, Pantelis Hadjizacharia, Linda S. Chan, Carlos Brown, Ali Salim, Peter M Rhee, Demetrios Demetriades

Research output: Contribution to journalArticle

34 Citations (Scopus)

Abstract

Background: The objective of this study was to evaluate the risk of mortality and complications associated with cirrhosis in trauma patients. Methods: This is an IRB-approved retrospective trauma registry study of patients admitted to an academic level 1 trauma center from 1997 to 2006. The following parameters were abstracted for analysis: age, gender, mechanism of injury, Abbreviated Injury Score, Injury Severity Score, Glasgow Coma Scale, mortality, and complications (ARDS, acute renal failure, pneumonia, intra-abdominal abscess, trauma-associated coagulopathy). Multivariable analysis was utilized to compare the mortality and complication rates between cirrhotic and noncirrhotic trauma patients. The subgroup of patients who underwent laparotomy was also analyzed. Results: During the 10-year study period there were 36,038 trauma registry patients, of which 468 (1.3%) had a diagnosis of cirrhosis. The mortality in the cirrhotic group was 12% vs. 6% in the noncirrhotic group [adjusted odds ratio = 5.65 (95% CI = 3.72 - 8.41, p < 0.0001)]. ARDS, trauma-associated coagulopathy, and septic complications were significantly more common in the cirrhotic group. The overall severe complication rate in the two groups was 10 and 4%, respectively [adjusted odds ratio = 2.05 (95% CI = 1.45 - 2.84, p < 0.0001)]. For the subgroup of patients who underwent emergent abdominal exploration, the mortality rate increased to 40% compared with that of noncirrhotics at 15% [adjusted odds ratio = 4.35 (95% CI = 2.00 - 9.18, p = 0.0002)]. Conclusion: Cirrhosis is an independent risk factor for increased mortality and higher complication rate following trauma. Injured patients who undergo laparotomy are significantly more likely to die than noncirrhotic patients. Injured patients with cirrhosis warrant aggressive monitoring and treatment.

Original languageEnglish (US)
Pages (from-to)1087-1092
Number of pages6
JournalWorld Journal of Surgery
Volume33
Issue number5
DOIs
StatePublished - May 2009

Fingerprint

Fibrosis
Wounds and Injuries
Mortality
Odds Ratio
Laparotomy
Registries
Abdominal Abscess
Glasgow Coma Scale
Injury Severity Score
Trauma Centers
Research Ethics Committees
Acute Kidney Injury
Pneumonia

ASJC Scopus subject areas

  • Surgery

Cite this

Georgiou, C., Inaba, K., Teixeira, P. G. R., Hadjizacharia, P., Chan, L. S., Brown, C., ... Demetriades, D. (2009). Cirrhosis and trauma are a lethal combination. World Journal of Surgery, 33(5), 1087-1092. https://doi.org/10.1007/s00268-009-9923-7

Cirrhosis and trauma are a lethal combination. / Georgiou, Chrysanthos; Inaba, Kenji; Teixeira, Pedro G R; Hadjizacharia, Pantelis; Chan, Linda S.; Brown, Carlos; Salim, Ali; Rhee, Peter M; Demetriades, Demetrios.

In: World Journal of Surgery, Vol. 33, No. 5, 05.2009, p. 1087-1092.

Research output: Contribution to journalArticle

Georgiou, C, Inaba, K, Teixeira, PGR, Hadjizacharia, P, Chan, LS, Brown, C, Salim, A, Rhee, PM & Demetriades, D 2009, 'Cirrhosis and trauma are a lethal combination', World Journal of Surgery, vol. 33, no. 5, pp. 1087-1092. https://doi.org/10.1007/s00268-009-9923-7
Georgiou C, Inaba K, Teixeira PGR, Hadjizacharia P, Chan LS, Brown C et al. Cirrhosis and trauma are a lethal combination. World Journal of Surgery. 2009 May;33(5):1087-1092. https://doi.org/10.1007/s00268-009-9923-7
Georgiou, Chrysanthos ; Inaba, Kenji ; Teixeira, Pedro G R ; Hadjizacharia, Pantelis ; Chan, Linda S. ; Brown, Carlos ; Salim, Ali ; Rhee, Peter M ; Demetriades, Demetrios. / Cirrhosis and trauma are a lethal combination. In: World Journal of Surgery. 2009 ; Vol. 33, No. 5. pp. 1087-1092.
@article{7db7fbffdf08485e8303a49264e89538,
title = "Cirrhosis and trauma are a lethal combination",
abstract = "Background: The objective of this study was to evaluate the risk of mortality and complications associated with cirrhosis in trauma patients. Methods: This is an IRB-approved retrospective trauma registry study of patients admitted to an academic level 1 trauma center from 1997 to 2006. The following parameters were abstracted for analysis: age, gender, mechanism of injury, Abbreviated Injury Score, Injury Severity Score, Glasgow Coma Scale, mortality, and complications (ARDS, acute renal failure, pneumonia, intra-abdominal abscess, trauma-associated coagulopathy). Multivariable analysis was utilized to compare the mortality and complication rates between cirrhotic and noncirrhotic trauma patients. The subgroup of patients who underwent laparotomy was also analyzed. Results: During the 10-year study period there were 36,038 trauma registry patients, of which 468 (1.3{\%}) had a diagnosis of cirrhosis. The mortality in the cirrhotic group was 12{\%} vs. 6{\%} in the noncirrhotic group [adjusted odds ratio = 5.65 (95{\%} CI = 3.72 - 8.41, p < 0.0001)]. ARDS, trauma-associated coagulopathy, and septic complications were significantly more common in the cirrhotic group. The overall severe complication rate in the two groups was 10 and 4{\%}, respectively [adjusted odds ratio = 2.05 (95{\%} CI = 1.45 - 2.84, p < 0.0001)]. For the subgroup of patients who underwent emergent abdominal exploration, the mortality rate increased to 40{\%} compared with that of noncirrhotics at 15{\%} [adjusted odds ratio = 4.35 (95{\%} CI = 2.00 - 9.18, p = 0.0002)]. Conclusion: Cirrhosis is an independent risk factor for increased mortality and higher complication rate following trauma. Injured patients who undergo laparotomy are significantly more likely to die than noncirrhotic patients. Injured patients with cirrhosis warrant aggressive monitoring and treatment.",
author = "Chrysanthos Georgiou and Kenji Inaba and Teixeira, {Pedro G R} and Pantelis Hadjizacharia and Chan, {Linda S.} and Carlos Brown and Ali Salim and Rhee, {Peter M} and Demetrios Demetriades",
year = "2009",
month = "5",
doi = "10.1007/s00268-009-9923-7",
language = "English (US)",
volume = "33",
pages = "1087--1092",
journal = "World Journal of Surgery",
issn = "0364-2313",
publisher = "Springer New York",
number = "5",

}

TY - JOUR

T1 - Cirrhosis and trauma are a lethal combination

AU - Georgiou, Chrysanthos

AU - Inaba, Kenji

AU - Teixeira, Pedro G R

AU - Hadjizacharia, Pantelis

AU - Chan, Linda S.

AU - Brown, Carlos

AU - Salim, Ali

AU - Rhee, Peter M

AU - Demetriades, Demetrios

PY - 2009/5

Y1 - 2009/5

N2 - Background: The objective of this study was to evaluate the risk of mortality and complications associated with cirrhosis in trauma patients. Methods: This is an IRB-approved retrospective trauma registry study of patients admitted to an academic level 1 trauma center from 1997 to 2006. The following parameters were abstracted for analysis: age, gender, mechanism of injury, Abbreviated Injury Score, Injury Severity Score, Glasgow Coma Scale, mortality, and complications (ARDS, acute renal failure, pneumonia, intra-abdominal abscess, trauma-associated coagulopathy). Multivariable analysis was utilized to compare the mortality and complication rates between cirrhotic and noncirrhotic trauma patients. The subgroup of patients who underwent laparotomy was also analyzed. Results: During the 10-year study period there were 36,038 trauma registry patients, of which 468 (1.3%) had a diagnosis of cirrhosis. The mortality in the cirrhotic group was 12% vs. 6% in the noncirrhotic group [adjusted odds ratio = 5.65 (95% CI = 3.72 - 8.41, p < 0.0001)]. ARDS, trauma-associated coagulopathy, and septic complications were significantly more common in the cirrhotic group. The overall severe complication rate in the two groups was 10 and 4%, respectively [adjusted odds ratio = 2.05 (95% CI = 1.45 - 2.84, p < 0.0001)]. For the subgroup of patients who underwent emergent abdominal exploration, the mortality rate increased to 40% compared with that of noncirrhotics at 15% [adjusted odds ratio = 4.35 (95% CI = 2.00 - 9.18, p = 0.0002)]. Conclusion: Cirrhosis is an independent risk factor for increased mortality and higher complication rate following trauma. Injured patients who undergo laparotomy are significantly more likely to die than noncirrhotic patients. Injured patients with cirrhosis warrant aggressive monitoring and treatment.

AB - Background: The objective of this study was to evaluate the risk of mortality and complications associated with cirrhosis in trauma patients. Methods: This is an IRB-approved retrospective trauma registry study of patients admitted to an academic level 1 trauma center from 1997 to 2006. The following parameters were abstracted for analysis: age, gender, mechanism of injury, Abbreviated Injury Score, Injury Severity Score, Glasgow Coma Scale, mortality, and complications (ARDS, acute renal failure, pneumonia, intra-abdominal abscess, trauma-associated coagulopathy). Multivariable analysis was utilized to compare the mortality and complication rates between cirrhotic and noncirrhotic trauma patients. The subgroup of patients who underwent laparotomy was also analyzed. Results: During the 10-year study period there were 36,038 trauma registry patients, of which 468 (1.3%) had a diagnosis of cirrhosis. The mortality in the cirrhotic group was 12% vs. 6% in the noncirrhotic group [adjusted odds ratio = 5.65 (95% CI = 3.72 - 8.41, p < 0.0001)]. ARDS, trauma-associated coagulopathy, and septic complications were significantly more common in the cirrhotic group. The overall severe complication rate in the two groups was 10 and 4%, respectively [adjusted odds ratio = 2.05 (95% CI = 1.45 - 2.84, p < 0.0001)]. For the subgroup of patients who underwent emergent abdominal exploration, the mortality rate increased to 40% compared with that of noncirrhotics at 15% [adjusted odds ratio = 4.35 (95% CI = 2.00 - 9.18, p = 0.0002)]. Conclusion: Cirrhosis is an independent risk factor for increased mortality and higher complication rate following trauma. Injured patients who undergo laparotomy are significantly more likely to die than noncirrhotic patients. Injured patients with cirrhosis warrant aggressive monitoring and treatment.

UR - http://www.scopus.com/inward/record.url?scp=67349166656&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=67349166656&partnerID=8YFLogxK

U2 - 10.1007/s00268-009-9923-7

DO - 10.1007/s00268-009-9923-7

M3 - Article

C2 - 19184637

AN - SCOPUS:67349166656

VL - 33

SP - 1087

EP - 1092

JO - World Journal of Surgery

JF - World Journal of Surgery

SN - 0364-2313

IS - 5

ER -