Risk factors and outcomes of acute respiratory distress syndrome in critically ill patients with cirrhosis

Aim Prior randomized controlled trials of acute respiratory distress syndrome (ARDS) excluded critically ill patients with cirrhosis. Data regarding risk factors for ARDS development and outcomes from ARDS in patients with cirrhosis are scarce. We sought to characterize outcomes from ARDS in patients with cirrhosis. Methods An observational cohort of patients with cirrhosis admitted to an intensive care unit at a high‐volume liver transplant center between 1 January 2012 and 31 December 2014 were reviewed. ARDS cases were identified according to the Berlin definition. Potential risk factors were examined in multivariable logistic regression analysis for ARDS development. Outcomes including in‐hospital mortality were compared between ARDS and non‐ARDS patients. Results A total of 559 patients met the inclusion criteria and 45 (8.1%) developed ARDS. Differences between ARDS and non‐ARDS patients included sepsis, Model for End‐Stage Liver Disease – Sodium score, and Sequential Organ Failure Assessment score. In‐hospital mortality was higher in cirrhotic patients with ARDS compared with those without ARDS (82.2% vs. 27.6%, P