Cirrhosis increases mortality and splenectomy rates following splenic injury

MacKenzie R. Cook, Kelly A. Fair, Jennifer Burg, Lindsay Cattin, Arvin Gee, Saman Arbabi, Martin Schreiber

    Research output: Contribution to journalArticle

    8 Citations (Scopus)

    Abstract

    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.

    Original languageEnglish (US)
    Pages (from-to)841-847
    Number of pages7
    JournalAmerican Journal of Surgery
    Volume209
    Issue number5
    DOIs
    StatePublished - May 1 2015

    Fingerprint

    Splenectomy
    Fibrosis
    Odds Ratio
    Nonpenetrating Wounds
    Confidence Intervals
    Mortality
    Wounds and Injuries
    Nonparametric Statistics
    Propensity Score
    End Stage Liver Disease
    Trauma Centers
    Chi-Square Distribution
    Case-Control Studies
    Logistic Models

    Keywords

    • Abdominal trauma
    • Blunt splenic injury
    • Cirrhosis
    • Nonoperative management

    ASJC Scopus subject areas

    • Surgery
    • Medicine(all)

    Cite this

    Cirrhosis increases mortality and splenectomy rates following splenic injury. / Cook, MacKenzie R.; Fair, Kelly A.; Burg, Jennifer; Cattin, Lindsay; Gee, Arvin; Arbabi, Saman; Schreiber, Martin.

    In: American Journal of Surgery, Vol. 209, No. 5, 01.05.2015, p. 841-847.

    Research output: Contribution to journalArticle

    Cook, MacKenzie R. ; Fair, Kelly A. ; Burg, Jennifer ; Cattin, Lindsay ; Gee, Arvin ; Arbabi, Saman ; Schreiber, Martin. / Cirrhosis increases mortality and splenectomy rates following splenic injury. In: American Journal of Surgery. 2015 ; Vol. 209, No. 5. pp. 841-847.
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    abstract = "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.",
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