Sepsis outcomes in patients with pre-existing liver disease

Introduction
To determine the characteristics, including the use of various diagnostic criteria, outcomes and treatment strategies in septic patients treated outside of the critical care area with pre-existing liver disease (LD).

Material and methods
The study population included patients recruited into two annual 24-hour prospective point-prevalence studies on the general wards and emergency departments across all Welsh acute hospitals in 2016 and 2017. Data were collected on patient demographics, observations and SIRS, SOFA and qSOFA scores.

Results
Out of 839 recruited patients, 24 (2.9%) had a past medical history of LD. 12/24 (50%) had a SIRS score ≥ 2, 21/24 (87.5%) a SOFA score ≥ 2 and 3/24 (12.5%) a qSOFA score ≥ 2. Patients with LD had 2.4 times higher odds (95% CI = 1.07-5.53, p = 0.03) of mortality after the sepsis episode. LD patients were younger than non-LD patients (p = 0.04) but not significantly different in frailty, do not attempt cardiopulmonary resuscitation (DNA-CPR) status or ceiling of care (p = 0.78, p = 0.54, p = 0.06, respectively).

Conclusions
The 90-day mortality was greater in patients with LD than the rest of the population. Management of sepsis in LD patients poses a challenge with current therapeutic bundles being underused and of unclear significance in improving patient outcome.