Liver cirrhosis: An unfavorable factor for nonoperative management of blunt splenic injury

Jen Feng Fang, Ray Jade Chen, Being Chuan Lin, Yu Bau Hsu, Jung Liang Kao, Miin Fu Chen

研究成果: 雜誌貢獻文章

29 引文 (Scopus)

摘要

Background: Nonoperative management (NOM) of blunt splenic injury (BSI) is currently a well-accepted treatment modality for hemodynamically stable patients. More than 60% of BSI patients can be successfully treated without operation. Old age, high-grade injury, contrast blush, and multiple associated injuries were reported to have a higher failure rate but not to be exclusive of NOM. The purpose of this study was to review the treatment courses and results of a special group of BSI patients with coexistent liver cirrhosis. Factors leading to poor results were analyzed and treatment strategy was proposed accordingly. Methods: During a 5-year period, 487 patients With BSI were treated following a standard protocol. Twelve of them had underlying liver cirrhosis. The medical records, radiographic findings, laboratory data, and operative variables were retrospectively reviewed. Results: Eighty-nine (18%) patients had immediate celiotomy for splenic hemorrhage with unstable hemodynamic status, 59 (12%) had non - spleen-related or nontherapeutic laparotomy, and 339 (70%) patients received NOM initially. Failure of NOM was found in 74 patients (22%). Twelve patients with initial NOM had coexistent liver cirrhosis. The amount of blood transfusion within 72 hours after admission for these 12 patients ranged from 4 to 26 units. Patients with coexistent liver cirrhosis and BSI had a significantly higher NOM failure rate (92% vs. 19%). In NOM failure patients, those with liver cirrhosis had lower Injury Severity Scores, lower splenic injury severity grades, more blood transfusions, and a higher mortality rate. Risk factors for mortality in these patients included a higher Injury Severity Score, a severely elevated prothrombin time (PT), a larger transfusion requirement, and a lower serum albumin level. Conclusion: Liver cirrhosis with subsequent development of portal hypertension, splenomegaly, and coagulopathy makes spontaneous hemostasis of the injured spleen difficult. NOM for BSI patients with coexistent liver cirrhosis carries a high failure and mortality rate. NOM may be successful in only a small group of patients with low-grade single-organ injury and with a normal or mildly elevated PT. Aggressive correction of coagulopathy should be performed in these patients. High-grade splenic injury, multiple associated injuries, and an elevated PT are indicators for early surgery. The mortality rate is high in patients with a severely prolonged PT irrespective of treatment modalities.

原文英語
頁(從 - 到)1131-1136
頁數6
期刊Journal of Trauma - Injury, Infection and Critical Care
54
發行號6
出版狀態已發佈 - 六月 1 2003
對外發佈Yes

指紋

Nonpenetrating Wounds
Liver Cirrhosis
Prothrombin Time
Injury Severity Score
Mortality
Multiple Trauma
Wounds and Injuries
Blood Transfusion
Spleen
Patient Admission
Splenomegaly
Portal Hypertension
Therapeutics
Hemostasis
Serum Albumin
Laparotomy

ASJC Scopus subject areas

  • Surgery

引用此文

Liver cirrhosis : An unfavorable factor for nonoperative management of blunt splenic injury. / Fang, Jen Feng; Chen, Ray Jade; Lin, Being Chuan; Hsu, Yu Bau; Kao, Jung Liang; Chen, Miin Fu.

於: Journal of Trauma - Injury, Infection and Critical Care, 卷 54, 編號 6, 01.06.2003, p. 1131-1136.

研究成果: 雜誌貢獻文章

Fang, Jen Feng ; Chen, Ray Jade ; Lin, Being Chuan ; Hsu, Yu Bau ; Kao, Jung Liang ; Chen, Miin Fu. / Liver cirrhosis : An unfavorable factor for nonoperative management of blunt splenic injury. 於: Journal of Trauma - Injury, Infection and Critical Care. 2003 ; 卷 54, 編號 6. 頁 1131-1136.
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title = "Liver cirrhosis: An unfavorable factor for nonoperative management of blunt splenic injury",
abstract = "Background: Nonoperative management (NOM) of blunt splenic injury (BSI) is currently a well-accepted treatment modality for hemodynamically stable patients. More than 60{\%} of BSI patients can be successfully treated without operation. Old age, high-grade injury, contrast blush, and multiple associated injuries were reported to have a higher failure rate but not to be exclusive of NOM. The purpose of this study was to review the treatment courses and results of a special group of BSI patients with coexistent liver cirrhosis. Factors leading to poor results were analyzed and treatment strategy was proposed accordingly. Methods: During a 5-year period, 487 patients With BSI were treated following a standard protocol. Twelve of them had underlying liver cirrhosis. The medical records, radiographic findings, laboratory data, and operative variables were retrospectively reviewed. Results: Eighty-nine (18{\%}) patients had immediate celiotomy for splenic hemorrhage with unstable hemodynamic status, 59 (12{\%}) had non - spleen-related or nontherapeutic laparotomy, and 339 (70{\%}) patients received NOM initially. Failure of NOM was found in 74 patients (22{\%}). Twelve patients with initial NOM had coexistent liver cirrhosis. The amount of blood transfusion within 72 hours after admission for these 12 patients ranged from 4 to 26 units. Patients with coexistent liver cirrhosis and BSI had a significantly higher NOM failure rate (92{\%} vs. 19{\%}). In NOM failure patients, those with liver cirrhosis had lower Injury Severity Scores, lower splenic injury severity grades, more blood transfusions, and a higher mortality rate. Risk factors for mortality in these patients included a higher Injury Severity Score, a severely elevated prothrombin time (PT), a larger transfusion requirement, and a lower serum albumin level. Conclusion: Liver cirrhosis with subsequent development of portal hypertension, splenomegaly, and coagulopathy makes spontaneous hemostasis of the injured spleen difficult. NOM for BSI patients with coexistent liver cirrhosis carries a high failure and mortality rate. NOM may be successful in only a small group of patients with low-grade single-organ injury and with a normal or mildly elevated PT. Aggressive correction of coagulopathy should be performed in these patients. High-grade splenic injury, multiple associated injuries, and an elevated PT are indicators for early surgery. The mortality rate is high in patients with a severely prolonged PT irrespective of treatment modalities.",
keywords = "Blunt splenic injury (BSI), Liver cirrhosis, Nonoperative management (NOM), Prothrombin time (PT)",
author = "Fang, {Jen Feng} and Chen, {Ray Jade} and Lin, {Being Chuan} and Hsu, {Yu Bau} and Kao, {Jung Liang} and Chen, {Miin Fu}",
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T1 - Liver cirrhosis

T2 - An unfavorable factor for nonoperative management of blunt splenic injury

AU - Fang, Jen Feng

AU - Chen, Ray Jade

AU - Lin, Being Chuan

AU - Hsu, Yu Bau

AU - Kao, Jung Liang

AU - Chen, Miin Fu

PY - 2003/6/1

Y1 - 2003/6/1

N2 - Background: Nonoperative management (NOM) of blunt splenic injury (BSI) is currently a well-accepted treatment modality for hemodynamically stable patients. More than 60% of BSI patients can be successfully treated without operation. Old age, high-grade injury, contrast blush, and multiple associated injuries were reported to have a higher failure rate but not to be exclusive of NOM. The purpose of this study was to review the treatment courses and results of a special group of BSI patients with coexistent liver cirrhosis. Factors leading to poor results were analyzed and treatment strategy was proposed accordingly. Methods: During a 5-year period, 487 patients With BSI were treated following a standard protocol. Twelve of them had underlying liver cirrhosis. The medical records, radiographic findings, laboratory data, and operative variables were retrospectively reviewed. Results: Eighty-nine (18%) patients had immediate celiotomy for splenic hemorrhage with unstable hemodynamic status, 59 (12%) had non - spleen-related or nontherapeutic laparotomy, and 339 (70%) patients received NOM initially. Failure of NOM was found in 74 patients (22%). Twelve patients with initial NOM had coexistent liver cirrhosis. The amount of blood transfusion within 72 hours after admission for these 12 patients ranged from 4 to 26 units. Patients with coexistent liver cirrhosis and BSI had a significantly higher NOM failure rate (92% vs. 19%). In NOM failure patients, those with liver cirrhosis had lower Injury Severity Scores, lower splenic injury severity grades, more blood transfusions, and a higher mortality rate. Risk factors for mortality in these patients included a higher Injury Severity Score, a severely elevated prothrombin time (PT), a larger transfusion requirement, and a lower serum albumin level. Conclusion: Liver cirrhosis with subsequent development of portal hypertension, splenomegaly, and coagulopathy makes spontaneous hemostasis of the injured spleen difficult. NOM for BSI patients with coexistent liver cirrhosis carries a high failure and mortality rate. NOM may be successful in only a small group of patients with low-grade single-organ injury and with a normal or mildly elevated PT. Aggressive correction of coagulopathy should be performed in these patients. High-grade splenic injury, multiple associated injuries, and an elevated PT are indicators for early surgery. The mortality rate is high in patients with a severely prolonged PT irrespective of treatment modalities.

AB - Background: Nonoperative management (NOM) of blunt splenic injury (BSI) is currently a well-accepted treatment modality for hemodynamically stable patients. More than 60% of BSI patients can be successfully treated without operation. Old age, high-grade injury, contrast blush, and multiple associated injuries were reported to have a higher failure rate but not to be exclusive of NOM. The purpose of this study was to review the treatment courses and results of a special group of BSI patients with coexistent liver cirrhosis. Factors leading to poor results were analyzed and treatment strategy was proposed accordingly. Methods: During a 5-year period, 487 patients With BSI were treated following a standard protocol. Twelve of them had underlying liver cirrhosis. The medical records, radiographic findings, laboratory data, and operative variables were retrospectively reviewed. Results: Eighty-nine (18%) patients had immediate celiotomy for splenic hemorrhage with unstable hemodynamic status, 59 (12%) had non - spleen-related or nontherapeutic laparotomy, and 339 (70%) patients received NOM initially. Failure of NOM was found in 74 patients (22%). Twelve patients with initial NOM had coexistent liver cirrhosis. The amount of blood transfusion within 72 hours after admission for these 12 patients ranged from 4 to 26 units. Patients with coexistent liver cirrhosis and BSI had a significantly higher NOM failure rate (92% vs. 19%). In NOM failure patients, those with liver cirrhosis had lower Injury Severity Scores, lower splenic injury severity grades, more blood transfusions, and a higher mortality rate. Risk factors for mortality in these patients included a higher Injury Severity Score, a severely elevated prothrombin time (PT), a larger transfusion requirement, and a lower serum albumin level. Conclusion: Liver cirrhosis with subsequent development of portal hypertension, splenomegaly, and coagulopathy makes spontaneous hemostasis of the injured spleen difficult. NOM for BSI patients with coexistent liver cirrhosis carries a high failure and mortality rate. NOM may be successful in only a small group of patients with low-grade single-organ injury and with a normal or mildly elevated PT. Aggressive correction of coagulopathy should be performed in these patients. High-grade splenic injury, multiple associated injuries, and an elevated PT are indicators for early surgery. The mortality rate is high in patients with a severely prolonged PT irrespective of treatment modalities.

KW - Blunt splenic injury (BSI)

KW - Liver cirrhosis

KW - Nonoperative management (NOM)

KW - Prothrombin time (PT)

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