Feasibility of detection and quantification of post icu syndrome in a cohort of cirrhosis patients

Background and Aims

Cirrhosis accounts for 3 to 4.5% of admissions to the Intensive Care Unit (ICU) and modern advances in ICU care have improved survival. Prolonged ICU stays are associated with physical and psychological sequelae like post -traumatic stress disorder, anxiety, depression and sexual dysfunction. Post intensive care syndrome (PICS) affects patients and families, and is associated with increased healthcare costs. Hitherto, the prevalence and severity of PICS in cirrhosis has not been investigated. This pilot study aims to determine its prevalence and the feasibility of using common psychological measures in its assessment.

Method

We identified patients with cirrhosis admitted to ICU for organ support from 2017 to 2021. Non-cirrhotic controls were randomly selected for the same period. Demographic data, aetiology and severity of cirrhosis, reason for ITU admission, mechanical ventilation duration, previous psychological morbidity, dependency and sedation details were recorded. Validated questionnaires [Pittsburgh Sleep Quality Index (PSQI), Montreal Cognitive Assessment (MOCA), Patient Health Questionnaire (PHQ-9), Impact of Events Scale, Generalized Anxiety Disorder 7 (GAD-7), and sexual dysfunction questionnaire] were used to assess for features of PICS in a post-ICU survival clinic or following contact by investigators. Mann-Whitney U test was used to detect statistical significance.

Results

36 chronic liver disease patients were screened for eligibility. 6 patients had died at the time of recruitment, 8 did not require organ support and 2 did not have a definitive diagnosis of cirrhosis and were excluded. 3 patients could not be contacted. 17 were included in the study. Controls were selected from an existing database of ICU patients. Mean age was 52 years in the cirrhosis group and 47 in controls. Aetiology of cirrhosis was alcohol in 70.6%, non-alcoholic fatty liver disease in 11.8%, autoimmune in 5.9% and cryptogenic in 5.9%. Mean MELD was 19 and mean ACLF score was 48. The mean intubation period was 13 days in the cirrhosis group and 23 in controls. 64.7% of the cirrhosis patients were sedated with propofol and fentanyl compared to 47.1% of controls. 35.3% of patients in cirrhosis group had a psychiatric background versus 17.6% of controls. 47.1% of cirrhosis patients required psychological support after ICU admission versus 35.29% of control. 5 of 6 psychological morbidity scores were numerically higher in the cirrhosis cohort, however statistical difference was not detected (see table 1).

Conclusion

We identified an increased need for psychiatric support post-ICU in cirrhosis patients compared to controls, though in this pilot study significant differences in morbidity was not detected through questionnaire returns. This signal requires further study in larger cohorts.