Liver Cirrhosis and Traumatic Brain Injury: A Fatal Combination Based on National Trauma Databank Analysis THOMAS LUSTENBERGER, M.D., PEEP TALVING,M.D., PH.D., LYDIA LAM, M.D., KENJI INABA, M.D., BERNARDINO CASTELO BRANCO, M.D., DAVID PLURAD, M.D., DEMETRIOS DEMETRIADES, M.D., PH.D. From the Division of Acute Care Surgery (Trauma, Emergency Surgery, and Surgical Critical Care), Department of Surgery, Keck School of Medicine, Los Angeles County + University of Southern California Medical Center, Los Angeles, California The purpose of this study was to evaluate the impact of liver cirrhosis on in-hospital outcomes in victims of isolated traumatic brain injury (TBI). This was a National Trauma Databank study over a 5-year period, including patients with isolated TBI. Propensity scores were calculated to match cirrhotic with noncirrhotic TBI patients in a 1:2 ratio. Primary outcomes included mortality, hos- pital and surgical intensive care unit length of stay, and ventilator days. Of the 35,005 patients with isolated TBI, 47 (0.13%) had documented liver cirrhosis. After matching with 94 noncirrhotic, isolated TBI patients, no differences with regards to demographic and clinical injury character- istics were observed comparing the two groups. The mean SICU length of stay for cirrhotic and noncirrhotic patients was 5.4 6 8.8 days and 3.7 6 7.0 days, respectively (P 5 0.079). Cirrhotic patients experienced significantly more ventilator days compared with their noncirrhotic coun- terparts (2.9 6 6.4 days vs 2.0 6 6.4 days; P 5 0.001). Overall mortality in the study population was 23.4 per cent with significantly higher in-hospital mortality among cirrhotic versus noncirrhotic TBI patients [34.0% vs 18.1%; odds ratio (95% confidence interval): 2.34 (1.05–5.20); P 5 0.035]. Traumatic brain injury in conjunction with liver cirrhosis is associated with two-fold increased mortality and significantly prolonged ventilator requirements when compared with their non- cirrhotic counterparts of isolated TBI. L IVER CIRRHOSIS has been identified as a significant risk factor for both morbidity and mortality in elective 1–5 and in emergently ill surgical patients. 6–15 In a previous investigation from our institution, cir- rhotic trauma patients undergoing laparotomy had an almost three-fold increased risk of developing severe complications and a seven-fold increased risk of death compared with a matched cohort of noncirrhotic trauma victims requiring emergent abdominal sur- gery. 6 In patients with traumatic brain injury (TBI), however, no studies exist documenting the impact of liver cirrhosis on their in-hospital outcomes. Thus, the aim of the present study was to evaluate the effect of cirrhosis on outcomes in patients with isolated TBI. Patients and Methods The National Trauma Databank (NTDB) version 7.0 was used for the purpose of this study, including data from 2002 to 2006. All patients with isolated TBI, defined as any intracranial injury without an extra- cranial injury, were identified using codes of the In- ternational Classification of Diseases—9th (ICD-9) revision. Cirrhotic patients were identified using the ICD-9 codes 571, 571.2, and 571.5. The following data was abstracted and analyzed: age, gender, mechanism of injury (blunt vs penetrating), Glasgow coma scale score at admission, Injury Severity Score, preexisting comorbidities, and sustained injuries. Primary out- comes included in-hospital mortality, hospital and surgical intensive care unit (SICU) length of stay, and ventilator days. Statistical Analysis Propensity scores (predicted probability of having a liver cirrhosis) were calculated for all isolated TBI patients using binary logistic regression. 16 Variables Address correspondence and reprint requests to Peep Talving, M.D., Ph.D., Assistant Professor of Surgery, University of South- ern California—Keck School of Medicine, Division of Acute Care Surgery (Trauma, Emergency Surgery, and Surgical Critical Care), Los Angeles County General Hospital, 1200 North State Street, IPT-C5L100, Los Angeles, CA, 90033-4525. E-mail: ptalving@ gmail.com. 311