Characteristics and prognosis of patients with cirrhosis presenting with acute respiratory distress syndrome: A bicentric retrospective study

Data on acute respiratory distress syndrome (ARDS) are scarce in patients with cirrhosis admitted to the intensive care unit (ICU). This study aimed to assess 28-day mortality among ventilated patients with cirrhosis presenting with ARDS and identify associated factors. We conducted a retrospective observational cohort study of consecutive mechanically ventilated patients with cirrhosis admitted to two ICUs between 1 February 2007 and 31 December 2021 and fulfilling ARDS criteria during ICU stay. Demographic, clinical, and biological data were collected, and factors associated with 28-day mortality were identified using multivariable logistic regression. Among 621 patients with cirrhosis requiring mechanical ventilation, 165 (26.6%) met ARDS criteria during their stay. Reasons for ICU admission included acute respiratory failure (52.1%), gastrointestinal bleeding with shock (18.2%), and septic shock (15.8%). The median Model for End-Stage Liver Disease score on admission was 29 (interquartile range [IQR]: 23–36) and Simplified Acute Physiologic Score II was 60 (IQR: 44–72). ARDS developed a median of 2 (IQR: 1–5) days after ICU admission, with a partial pressure of arterial oxygen to fraction of inspired oxygen (PaO 2 /FiO 2 ) ratio of 118 mmHg. Twenty-eight-day mortality was 75.2% and did not change over the study period (80.9% in 2007–2014 vs . 68.4% in 2015–2021, P =0.064). On multivariate analysis, factors associated with 28-day mortality were MELD score (odds ratio [OR]=2.31, 95% confidence interval [CI]: 1.48 to 3.80; P <0.001), PaO 2 /FiO 2 ratio at ARDS onset (OR=0.49, 95% CI: 0.24 to 0.97; P =0.039) and ICU admission for acute respiratory failure (OR=0.44, 95% CI: 0.19 to 0.97; P =0.047). ARDS is common among patients with cirrhosis admitted to the ICU. Mortality remains high and has not improved over the past decade. Identifying factors associated with mortality may help guide treatment intensity in this population.