Abstract
Introduction Acute Physiology and Chronic Health Evaluation (APACHE) II and III and Sequential Organ Failure Assessment (SOFA) are prognostic scores commonly used in the intensive care unit (ICU). Their accuracy in predicting mortality has not been adequately evaluated in comparison to prognostic scores commonly used in critically ill cirrhotic patients with acute decompensation (AD) or acute-on-chronic liver failure (ACLF). Aims This study was conducted to evaluate the performance of prognostic scores, including APACHE II, SOFA, Chronic Liver Failure Consortium (CLIF-C) SOFA, Child–Turcotte–Pugh (CPS), Model for End-Stage Liver Disease (MELD), MELD-Na, MELD to serum sodium ratio (MESO) index, CLIF-C organ failure (CLIF-C OF), CLIF-C ACLF, and CLIF-C AD scores, in predicting mortality of cirrhotic patients admitted to the ICU. Patients and Methods. A total of 382 patients (280 males, mean age 67.3 ± 10.6 years) with cirrhosis were retrospectively evaluated. All prognostic scores were calculated in the first 24 hours of ICU admission. Their ability to predict mortality was measured using the analysis of the area under the receiver operating characteristic curve (AUC). Results Mortality was observed in 31% of the patients. Analysis of AUC revealed that CLIF-C OF (0.807) and CLIF-SOFA (0.776) had the best ability to predict mortality in all patients, but CLIF-C OF (0.749) had higher prognostic accuracy in patients with ACLF. CLIF-SOFA, SOFA, and CLIF-C AD had the highest AUC values in patients with AD, with no statistical difference (p=0.971). Conclusions When compared to other general or liver-specific prognostic scores, CLIF-C OF, CLIF-SOFA, SOFA, and CLIF-C AD have good accuracy to predict mortality in critically ill patients with cirrhosis and patients with AD. According to the clinical scenario, different scores should be used to provide prognosis to patients with cirrhosis in the ICU.
Highlights
Acute Physiology and Chronic Health Evaluation (APACHE) II and III and Sequential Organ Failure Assessment (SOFA) are prognostic scores commonly used in the intensive care unit (ICU). eir accuracy in predicting mortality has not been adequately evaluated in comparison to prognostic scores commonly used in critically ill cirrhotic patients with acute decompensation (AD) or acute-on-chronic liver failure (ACLF)
All patients admitted to the Gastroenterology and Hepatology Unit of Hospital Portugues, from January 2012 to June 2018, with AD of cirrhosis or ACLF, were retrospectively reviewed. is ICU is a referral unit for critically ill patients with cirrhosis in Salvador, Brazil. e diagnosis of cirrhosis was based on clinical, biochemical, and echographic findings, as well as liver histology, whenever liver biopsy results were available. e etiology of cirrhosis and clinical features responsible for ICU admission were recorded in all patients
All general and liverspecific prognostic scores were significantly higher in nonsurvivors when compared to their counterparts who were discharged alive from the hospital, except for the CLIFC AD score (Table 2)
Summary
End-stage liver disease, due to hepatitis B and C, alcoholic liver disease, and nonalcoholic steatohepatitis, accounts roughly for 1.16 million deaths worldwide [1]. E most often used ICU scores are Acute Physiology and Chronic Health Evaluation (APACHE) II and III and Sequential Organ Failure Assessment (SOFA) scores [17], whereas liver-specific scores routinely applied to patients with cirrhosis are Child–Turcotte–Pugh (CTP) and Model for End-Stage Liver Disease (MELD) scores [18, 19]. Both were designed to predict mortality in patients with cirrhosis, respectively, after surgery [18] and transjugular intrahepatic portosystemic shunt (TIPS) placement [19]. E purpose of the present study was to evaluate the accuracy of liver-specific prognostic scores, such as CTP, MELD, and its variants MELD-Na, iMELD, and MESO index, as well as ICU scores, such as APACHE II and SOFA, in their ability to predict in-hospital mortality of cirrhotic patients admitted to the ICU with either AD of cirrhosis or ACLF and to assess the performance of CLIF-C AD and CLIF-C ACLF, respectively, in those patients with either AD or ACLF
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