TY - JOUR
T1 - Cirrhosis increases mortality and splenectomy rates following splenic injury
AU - Cook, MacKenzie R.
AU - Fair, Kelly A.
AU - Burg, Jennifer
AU - Cattin, Lindsay
AU - Gee, Arvin
AU - Arbabi, Saman
AU - Schreiber, Martin
N1 - Publisher Copyright:
© 2015 Elsevier Inc. All rights reserved.
PY - 2015/5/1
Y1 - 2015/5/1
N2 - Background Cirrhosis may be a risk factor for mortality following blunt splenic injury (BSI) and it predicts the need for an operative intervention. Methods We performed a case-control study at 3 level 1 trauma centers. Comparisons were made with chi-square test, Wilcoxon rank-sum test, and binary logistic regression, and stratified by propensity for splenectomy. Data are presented as odds ratios (ORs) and 95% confidence intervals (95% CIs). Results Mortality was 27% (21/77) and cirrhosis was a strong risk factor for death (OR 8.8, 95% CI 3.7 to 21.1). Compared with controls, cirrhosis was an independent risk factor for splenectomy (OR 5.4, 95% CI 2.5 to 11.5), and only splenic injury grade was associated with splenectomy (OR 2.2, 95% CI 1.3 to 3.6). Only admission model for end-stage liver disease was independently associated with mortality after an operation (OR 1.7, 95% CI 1.1 to 2.8). After propensity score matching, we found no association between splenectomy and mortality in cirrhotic patients. Conclusion Cirrhosis dramatically increases mortality and the odds of an operative intervention in BSI patients with pre-existing cirrhosis, and BSI requires vigilant attention and early intervention should be considered.
AB - Background Cirrhosis may be a risk factor for mortality following blunt splenic injury (BSI) and it predicts the need for an operative intervention. Methods We performed a case-control study at 3 level 1 trauma centers. Comparisons were made with chi-square test, Wilcoxon rank-sum test, and binary logistic regression, and stratified by propensity for splenectomy. Data are presented as odds ratios (ORs) and 95% confidence intervals (95% CIs). Results Mortality was 27% (21/77) and cirrhosis was a strong risk factor for death (OR 8.8, 95% CI 3.7 to 21.1). Compared with controls, cirrhosis was an independent risk factor for splenectomy (OR 5.4, 95% CI 2.5 to 11.5), and only splenic injury grade was associated with splenectomy (OR 2.2, 95% CI 1.3 to 3.6). Only admission model for end-stage liver disease was independently associated with mortality after an operation (OR 1.7, 95% CI 1.1 to 2.8). After propensity score matching, we found no association between splenectomy and mortality in cirrhotic patients. Conclusion Cirrhosis dramatically increases mortality and the odds of an operative intervention in BSI patients with pre-existing cirrhosis, and BSI requires vigilant attention and early intervention should be considered.
KW - Abdominal trauma
KW - Blunt splenic injury
KW - Cirrhosis
KW - Nonoperative management
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U2 - 10.1016/j.amjsurg.2015.01.009
DO - 10.1016/j.amjsurg.2015.01.009
M3 - Article
C2 - 25769879
AN - SCOPUS:84929023657
SN - 0002-9610
VL - 209
SP - 841
EP - 847
JO - American journal of surgery
JF - American journal of surgery
IS - 5
ER -