Child-Pugh class C liver cirrhosis is an independent prognostic factor in

The mortality rate of ARDS (acute respiratory distress syndrome) patients varies according to therapeutic modalities, the cause and severity of ARDS, and the presence of associated organ failure. The aim of this study was to determine the influence of liver cirrhosis on clinical outcome in ARDS patients. We retrospectively obtained the age, sex, and the underlying disease of 170 ARDS patients admitted to the medical intensive care unit. There were 3 groups of patients: the first group was ARDS patients with liver cirrhosis (LC, n=49), the second group was ARDS patients with other chronic diseases (n=72) and the third group was ARDS patients without any other logical, biochemical, metabolic, and inflammatory reactions. The liver plays a pivotal role not only in the defense mechanism of the host but also in many aspects of immunologic and metabolic processes [9]. It has been reported that liver failure is a poor prognostic factor in multiple-organ failure patients with sepsis [9,10] and ARDS patients [11,12]. The role of liver failure in promoting ARDS is partly evidenced by the fact that when patients had ARDS associated with end-stage liver failure, the pulmonary disease completely recovers with successful liver transplantation [13]. However, the clinical impact of liver cirrhosis on the outcome of ARDS patients has not been well addressed. There are several potential factors that badly influence the outcome of ARDS in patients with liver cirrhosis. Forty five percent patients with liver cirrhosis develope hypoxia [14]. The hypoxia is resulted from an intrapulmonary shunt, a portovenous shunt, decrease of diffusion capacity, or ventilation perfusion mismatching [15]. The ascites which is frequently associated with liver cirrhosis can influence the lung mechanism. Moreover, the liver may be a major source of inflammatory cytokines that are involved in the pathogenesis of acute lung injury From the Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea. (Drs. Eun Kyung Kim, Tae Sun Shim, Chae Man Lim, Sang Do Lee, Woo Sung Kim, Dong Soon Kim, Won Dong Kim, And Younsuck Koh). Address requests for reprints to: Younsuck Koh, M.D., Division of Pulmonary and Critical Care Medicine. Department of Internal Medicine, Asan Medical Center, 388-1 Pungnap-dong, Songpa-ku, Seoul, 138-736, Korea Phone: 82-2-3010-3130. Fax: 82-2-3010-6968 E-mail: diseases(n=49). The overall mortality rate was 56.5%. The GOCA (Gas exchange, Organ failure, Cause, Associated diseases) score, mortality, the incidence of ARDS due to sepsis and the number of organ failures were higher in the LC group than in the other 2 groups. Serum albumin, sodium, the occurrence of other organ failure, GOCA score, SAPS II (Simplified Acute Physiology Score II) were independently associated with mortality. In univariate analysis, the presence of liver cirrhosis was found to be associated with a higher mortality, and Child- Pugh class C liver cirrhosis was an independent prognostic factor of ARDS.