Is LiFe worth living? It all depends on the liver

Abstract

Regardless of the initial cause, critical illness almost invariably involves serious derangement of function across multiple organs and body systems. While much attention has rightly been directed towards the development of predictive models which seek to measure illness severity and forecast outcome in severe multiple organ failure, severe respiratory failure and renal injury, less work has been undertaken to elucidate the specific impact of acute hepatic dysfunction in the context of chronic liver disease—despite recognition that liver injury in critically ill patients is associated with poor outcome . The complex care needs and high mortality of patients with severe acute liver failure is well-described, and approaches for predicting outcomes for patients with chronic liver disease, decompensated cirrhosis and cirrhotic patients in the intensive care unit (ICU) are established. Regardless of these advances, however, the importance of evolving hepatic dysfunction as part of an overall non-liver specific critical illness may still be underappreciated , even in patients with known chronic liver problems. In their work to develop a laboratory-based liver injury failure evaluation (LiFe) score, Edmark et al. outline an interesting approach to the development, validation and potential application of a simple tool that may assist intensivists in the evaluation and management of patients with known chronic liver disease admitted to the ICU.