Critical Care Medicine

Medical Intensive Liver Unit

Cleveland Clinic’s Medical Intensive Liver Unit (MILU), a collaboration of critical care and hepatology, opened in summer 2018. One of only a few liver-specific intensive care units in the US, it provides multidisciplinary care for critically ill patients with liver failure. Patients cared for in the MILU have acute liver failure, acute-on-chronic liver failure, and decompensated cirrhosis and its complications. Critically ill patients waiting or being evaluated for liver transplant receive care in the MILU from a multidisciplinary team that includes specialists in critical care, hepatology, pathology, transplant, social work, pharmacology, nursing, nutrition, and physical therapy. In 2021, 344 patients were admitted to the MILU; 201 of these patients were listed for transplant and 50 (25%) patients received a liver transplant during their hospital stay with 34 (68%) patients going to the operating room directly from the MILU.

The MILU care team strives to provide optimal medical management of these patients with complex conditions no matter what the long term goal. Whether optimizing their status in preparation for a transplant, returning them back to a normal life at home, or having timely, compassionate goals of care conversations, the MILU metrics reflect excellent care.

Mean MILU APACHE III Score

2019 – 2021

APACHE III = Acute Physiology And Chronic Health Evaluation, a severity-of-disease classification system, MILU = Medical Intensive Liver Unit

ᵃBenchmark is for national average for all critical care patients. National average of 54.5 reflects the current practice of critical care in the US for a large adult population.

ᵇAugust 2018 to December 2019

The acuity and complexity of the MILU patient population is very high as demonstrated by the overall APACHE III acuity score, which is well above the national average of 54.5 from a population that reflects the current practice of critical care in the US.¹ Similar to APACHE scoring system, the MELD-Na score (Model For End-Stage Liver Disease) reflects the severity of liver illness. In 2021, the average MELD-Na was 27.6, a decrease from 30.1 in 2020.

Reference

  1. Lilly CM, Zuckerman IH, Badawi O, Riker RR. Benchmark data from more than 240,000 adults that reflect the current practice of critical care in the United States. Chest. 2011 Nov;140(5):1232-1242.
MILU In-Hospital Mortality Rate

2019 – 2021

MILU = Medical Intensive Liver Unit

ᵃAugust 2018 to December 2019

The unadjusted mortality rate remained stable during the last 2 years.

MILU Discharge From Hospital Location

2019 – 2021

MILU = Medical Intensive Liver Unit

ᵃAugust 2018 to December 2019

A key outcome is the percentage of patients discharged to home or rehabilitation (either at home or a facility), which continues to rise.