Impacto de la Cirrosis en el Trauma

Impact of Cirrhosis on Outcomes in Trauma
Abstract presented at the Pennsylvania ACS Committee on Trauma resident paper competition, Harrisburg, PA, October 29, 2004; and the Regional ACS Committee on Trauma resident paper competition, Washington, DC, December 4, 2004.
Dale A. Dangleben MD, a, Omid Jazaeri MDa, Thomas Wasser PhDa, Mark Cipolle MD, PhDa and Michael Pasquale MD, FACSa aDepartment of Surgery, Lehigh Valley Hospital, Allentown, PA. Received 2 June 2006; revised 27 July 2006; accepted 1 August 2006. Available online 2 October 2006.

Background
Cirrhosis as an independent predictor of poor outcomes in trauma patients was identified in 1990. We hypothesized that the degree of preinjury hepatic dysfunction is, by itself, an independent predictor of mortality.
Study design
The trauma registry at our Level I trauma center was queried for all ICD-9 codes for liver disease from 1999 to 2003, and patients were categorized as having Child-Turcotte-Pugh (CTP) class A, B, or C cirrhosis. Data analyzed included age, mechanism of injury, Abbreviated Injury Score (AIS), Injury Severity Score (ISS), Glasgow Coma Score (GCS), hospital length of stay, ventilator days, procedures performed, transfusion of blood products, admission lactate, base deficit, and mortality. Trauma Related Injury Severity Score (TRISS) methodology was used to calculate the probability of survival. Outcomes data were analyzed, and statistical comparison was performed using group t-test.
Results
Of the 50 patients meeting study criteria, 31 had alcohol-related cirrhosis, 18 had a history of hepatitis C, and 1 had cryptogenic cirrhosis. Twenty (40%) met CTP A classification, 16 (32%) met CTP B criteria, and 14 (28%) had CTP class C cirrhosis. One death occurred in the CTP A and B groups. Comparison between the five survivors and nine nonsurvivors from CTP class C showed no statistical significance in terms of age, ISS, TRISS, or GCS.

Conclusions
The mortality rate for class C cirrhotic patients posttrauma continues to be higher than that predicted by TRISS, although patients with less severe hepatic dysfunction do not appear to have significantly lower than predicted survival. The degree of hepatic dysfunction remains an independent predictor of mortality and CTP C criteria must be considered when determining outcomes for patients posttrauma.