Exploring Rapid Response Team Activation Impact in Patients with Cirrhosis with Acute Decompensation.

Abstract

Background: Cirrhosis is associated with significant healthcare utilization, yet data about in-hospital decompensations remain sparse. Additionally, the impact of liver transplant candidacy status on resuscitation and outcomes is largely unknown.

Aims: We aimed to evaluate the characteristics of resuscitation events for patients with cirrhosis with acute decompensation, analyzing liver transplant candidacy and intensive care unit (ICU) transfer parameters.

Methods: Retrospective single-center review of adult patients with liver cirrhosis who had a rapid response team (RRT) activation during hospitalization and no prior liver transplantation.

Results: Patients with cirrhosis who were liver transplant candidates were more likely to be younger (p = .003), have a higher serum total bilirubin (p = .015), higher INR (p < .001), and higher MELD 3.0 (p = .006). There was no significant difference in ICU transfer (p = .170) after RRT activation. Liver transplant candidates had a lower 30- and 60-day mortality (p = .008, p = .014) and were less likely to have a code status discussion after decompensation (p = .001). Lower serum albumin was associated with ICU transfer (p = .001). Patients who transferred to the ICU were more likely to have a code status discussion within 24 h after RRT (p = .011) without significant difference in 30- or 60-day mortality (p = .059, p = .277).

Conclusions: Liver transplant candidacy in patients with cirrhosis with acute decompensation is not clearly correlated with ICU transfer. Liver transplant candidates are more likely to be younger, have higher MELD 3.0 scores, less likely to have code status discussed after RRT, and have lower 30- and 60-day mortality rates. Patients who transfer to the ICU are more likely to have a code status discussion without any significant difference in 30- or 60-day mortality.