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 2022, 342 patients were admitted to the MILU. While in the MILU, 170 of these patients were evaluated for liver transplant. Out of those 170 patients, 69 (40.6%) were listed and 54 (31.8%) received a liver transplant during their hospital stay, with 35 (20.6%) 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.


Cleveland Clinic Respiratory Institute hosts two different podcasts, available on Apple, Google, Soundcloud and Spotify. Click on a link below to listen to the following podcast:

‘Medical Intensive Liver Unit: An ICU for Advanced Liver Disease Patients’ hosted by Raed Dweik, MD, MBA, Chair of the Respiratory Institute at Cleveland Clinic, with guest Aanchal Kapoor, MD, MEd, Director of the Medical Intensive Liver Unit (MILU).


2020 – 2022

MELD-Na Score

2020 – 2022

APACHE = The Acute Physiology and Chronic Health Evaluation system, MELD-Na = model for end-stage liver disease-sodium added, 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.

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 the APACHE scoring system, the MELD-Na score reflects the severity of liver illness. In 2022, the average MELD-Na was 32, an increase from the 2021 score of 27.6. The average MELD-Na score for those patients receiving transplants was also higher in 2022 at 37.03, up from 36 in 2021.


  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 ICU Mortality Rate (Observed to Expected)

2020 – 2022

MILU Hospital Mortality Rate (Observed to Expected)

2020 – 2022

MILU = Medical Intensive Liver Unit

The above graphs reflected the Standard Mortality Ratio compared to similar institutions.

MILU Discharge From Hospital Location

2020 – 2022

MILU = Medical Intensive Liver Unit

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