S2779 Five-Year Real-World Experience of a Dedicated Medical Intensive Liver Unit (MILU)

Introduction: The Medical Intensive Liver Unit (MILU) was established as a dedicated Intensive Care Unit (ICU) model designed to deliver multidisciplinary, liver-focused critical care. Real-world data describing patient outcomes remain scarce despite the growing implementation of these units. We report 5 years of MILU outcomes from a large quaternary referral center to help address this gap. Methods: We performed a retrospective cohort analysis of all admissions to the MILU between August 2018 and August 2023. Data were extracted on patient demographics, disease severity scores, acute on chronic liver failure (ACLF) classification, liver transplant (LT) status, and survival. Descriptive statistics were used to summarize baseline characteristics and clinical variables. Results: Over the 5-year study period, 1,192 unique patients accounted for 1,570 MILU admissions, with 380 (24.2%) representing readmissions. The distribution of race, ethnicity, and sex remained similar between 2018 to 2023 with male patients comprising approximately 52%-68% of the cohort annually. Alcohol associated liver disease (44.3%) and metabolic dysfunction-associated cirrhosis (14.0%) were the most prevalent etiologies of liver disease. The most common primary admission diagnoses were gastrointestinal bleeding (25.6%) and circulatory shock (23.4%). Median MELD-Na was 29 (IQR 23–34) and median Sequential Organ Failure Assessment (SOFA) Score ranged from 10-12. ACLF was diagnosed in 625 patients (39.8%) at the time of MILU admission, with 132 (21.0%) classified as Grade 1, 211 (33.6%) as Grade 2, and 285 (45.4%) as Grade 3. Overall, 478 patients (40.1%) underwent LT evaluation in the MILU, of whom 233 (19.6%) were successfully transplanted, including 127 (10.7%) who received a transplant directly during their MILU admission. At the time of discharge, 855 (71.7%) were alive. Conclusion: This 5-year experience from a dedicated MILU highlights the value of a specialized, multidisciplinary care model in the management of critically ill patients with advanced liver disease. Despite high severity of illness, nearly 20% of patients eventually underwent LT, and over 70% were alive at discharge. The MILU model facilitated the delivery of targeted, evidence-based organ-specific support, timely identification and evaluation of LT candidates, and structured transitions following ICU care. These findings suggest that the MILU framework may serve as a model for improving outcomes in this high-risk population.