M. L. Kueht1, R. A. Helmick3, S. Bebko2, S. Awad1,2 1Baylor College Of Medicine,Department Of Surgery,Houston, TX, USA 2Michael E. Debakey VA Medical Center,Department Of Surgery/Critical Care,Houston, TX, USA 3Mayo Clinic, Rochester,Department Of Surgery, Division Of Transplantation Surgery,Rochester, MN, USA
Introduction: Hepatitis C infection is thought to cause immune dysfunction through chronic inflammation and immune dysregulation. The clinical impact in the ICU of Hepatitis C Virus (HCV) status outside of active infection or cirrhosis is not well described. We aim to characterize the clinical ramifications of HCV status on patients admitted to the surgical ICU.
Methods: All patients admitted to our ICU between 2008 and 2012 were included. Demographic variables collected included age, BMI, MELD and APACHE II scores, and co-morbidities such as coronary artery disease (CAD), hypertension (HTN), hyperlipidemia (HLD), chronic kidney disease (CKD), cancer history, alcohol use, and HIV status. Outcomes evaluated were mortality in the ICU and while in the hospital, ICU and hospital length of stay, and infectious complications in the ICU such as ventilator associated pneumonia, and urinary tract, surgical site, and catheter related blood stream infections. Comparisons were made based on HCV status as well as sub-group analyses based on the presence or absence of cirrhosis. Statistical comparisons were performed with Fisher’s Exact tests and student t-tests where appropriate. Multivariate logistic regression was performed to identify potential predictors of infectious ICU complications.
Results: A total of 1672 patients were identified during the study period, of which 152 (10%) were HCV positive. The mean age of the cohort was 64.1 and the mean APACHE score was 13. The HCV-negative patients were significantly older (64.5 vs 60.1yrs, p<0.01), had increased BMI (28.8 vs 26.3 kg/m2, p<0.01), and had more CAD (40.9 vs 2.1%, p<0.01), HLD (58.3 vs 23.7%, p<0.01), HTN (71.7 vs 57.9%, p<0.01), and CKD (5.9 vs 2.0%, p=0.04). In the HCV-positive patients, there was a higher incidence of cirrhosis (25.7 vs 1.4%, p<0.01), hematologic (2.6 vs 0.5%, p=0.02) and solid organ cancers (27.0 vs 17.9%, p<0.01), HIV (3.3 vs 0.6%, p<0.01), and alcohol abuse (12.5 vs 3.1%, p<0.01). APACHE II (p=0.04) and MELD (p<0.01) scores on admission were higher in HCV-positive patients. ICU length of stay was longer for HCV-positive patients (6.8 vs 5.5 days, p=0.03). Between the HCV groups overall, there were no significant differences in mortality or any of the infectious complications. However, in the non-cirrhotic patients, those with HCV had significantly increased in-hospital mortality, p<0.01. Multivariate logistic regression identified admission APACHE II score as an independent predictor of SICU infectious complications.
Conclusion: Our HCV-positive cohort was younger, had lower BMI, and less cardiac co-morbidity, yet still spent more time in the ICU. Also, in the absence of cirrhosis, HCV-positive patients had increased in-house mortality. Contrary to our hypothesis, this study demonstrates that despite theorized immunosuppression from HCV infection, HCV status was not associated with ICU infectious complications. This warrants further study.