Scoring System For Mortality Research Articles

Abstract P-318: DOES MICROALBUMINURIA PREDICT MORTALITY IN PATIENTS ADMITTED TO THE PEDIATRIC INTENSIVE CARE UNIT?

Aims & Objectives: Microalbuminuria is an earlier sign of vascular damage. Hovewer it is accepted as an increased risk for cardiovascular morbidity and mortality especially in high risk populations such as diabetics and hypertensives. We aimed to evaluate the prognostic value of microalbuminuria in children admitted to the pediatric intensive care unit (PICU). Methods In this prospective study we measured the microalbumin levels of patients admitted to the our 12 bed pediatric intensive care unit in an university hospital between December 2014 and November 2015. 250 patients included who were 1 month to 18 years old, monitored at least 24 hours in PICU and meeting study criteria. PRISM III and PELOD scores were calculated for all patients. The collected data was analyzed with statistical methods and compared with mortality scoring systems and observed mortality. Results Microalbuminuria values were significantly higher in non-survivors (48 mg/g) than the average of survivors (18 mg/g) (p<0,05). At a cut off value of 32 mg/g, albumin-creatinine ratio measured at admission may be able to discriminate between patients a with sensitivity of 85%, and specificity of 70% (p<0,01). Conclusions Microalbuminuria may be used as a simple and useful to predict mortality in PICU. Additionally microalbuminuria may be involved in the pediatric mortality scoring systems in the future.

Prognostic models for predicting the severity and mortality in people with acute pancreatitis

This is a protocol for a Cochrane Review (Prognosis). The objectives are as follows: The primary objective is to synthesise available evidence from external validation studies evaluating the predictive accuracy of clinical scoring systems (measured on admission and up to 48 hours following admission) for severity and mortality within six months in people with acute pancreatitis. The secondary objective is to compare different risk thresholds of available scoring systems (i.e. the level at which the risk of severe acute pancreatitis or mortality is considered to be high) to predict severity and mortality within six months in people with acute pancreatitis. For both objectives, we will explore differences in patient populations, length of follow‐up, and study design as potential sources of between‐study heterogeneity.

Performance of PRISM score III in predicting the outcome of patients admitted in tertiary care pediatric intensive care unit (P.I.C.U.): A pilot study

Introduction: P.I.C.U is a unit that provides care to the critically ill patients with purpose of reducing the rate of mortality and morbidity. Various scoring systems are used to assess and compare the standards of care of different P.I.C.U.s. Among them, PRISM III scoring has shown promising results, especially in developing countries. In Pakistan, these studies are fewer in numbers with conflicting results in different hospital settings (private and public sector). Since our hospital is also a tertiary care hospital, we planned a pilot study to evaluate PRISM III score in our P.I.C.U. Objective: To evaluate the performance of PRISM III score in predicting the outcome of patients admitted in P.I.C.U of tertiary care hospital of Karachi. Method: PRISM III is Pediatric Risk of Mortality Scoring system consisting of clinical assessment (Glasgow Coma Scale, pupillary reflex, temperature, heart rate, systolic blood pressure) and lab parameters (arterial blood gas, urea, nitrogen, creatnine, blood sugar, potassium, white cell count, platelets, PT/APTT). It is a cross-sectional study and data was collected from admitted patients in P.I.C.U, Unit II of Abbasi Shaheed Hospital during 1st October to 31st December 2016. PRISM score is being calculated from all the patients within 24 hours of admission. Result: Total of 70 patients of which 51(72%) survived and 19(27%) expired. 49 were males and 21 females. Age range of non-survivors was 2 to 18 months. Duration of PI.C.U stay was 72 hours for survivors. Patients who were referred, had malnutrition, depressed mental status, deranged renal functions and required mechanical ventilation during first hour of admission had poor outcome. Out of 19 non-survivors, PRISM III predicted mortality in 15 patients (78.9%). Conclusion: High total PRISM III score was significantly associated with poor outcome i.e. death in this pilot study. Thus PRISM III score was found to be a valid predictor of outcome in our P.I.C.U. There is no conflict of interest keywords: P.I.C.U, Mortality, PRISM III score, Outcome.

Modernising Hip Fracture Anaesthesia.

Hip fracture carries a 30-day mortality of around 8% in the United Kingdom. This figure has remained relatively unchanged despite modern developments in anaesthetic technique. These range from improvements in perioperative analgesia and mortality scoring systems, changes to intra-operative anaesthetic technique and strategies to reduce the requirement for blood transfusion. In this article, we review the current literature on the perioperative management of patients undergoing hip fracture surgery including some of the current controversies.

Prognostic significance of a comprehensive histological evaluation of reticulin fibrosis, collagen deposition and osteosclerosis in primary myelofibrosis patients.

To evaluate whether a comprehensive histological evaluation of reticulin fibrosis, collagen deposition and osteosclerosis in bone marrow trephine biopsies (BMBs) of primary myelofibrosis (PMF) patients may have prognostic implications. Reticulin fibrosis, collagen deposition and osteosclerosis were graded from 0 to 3 in a series of 122 baseline BMBs. Then, we assigned to each case a comprehensive score [reticulin, collagen, osteosclerosis (RCO) score, ranging from 0 to 9] that allowed us to distinguish two groups of patients, with low-grade (RCO score 0-4) and high-grade (RCO score 5-9) stromal changes. Of 122 patients, 88 displayed a low-grade and 34 a high-grade RCO score. The latter was associated more frequently with anaemia, thrombocytopenia, peripheral blood blasts and increased lactate dehydrogenase levels. The RCO score was correlated strictly with overall mortality (P = 0.013) and International Prognostic Scoring System (IPSS) risk categories, and was able to discriminate the overall survival of both low- and high-grade patients (log-rank test: P < 0.001). Moreover, it proved to be more accurate than the European Consensus on Grading of Bone Marrow Fibrosis (ECGMF grade) in identifying high-risk patients with poor prognosis. Finally, a combined analysis of RCO scores and IPSS risk categories in an integrated clinical-pathological evaluation was able to increase the positive predictive value (PPV) for mortality in high-risk patients. The comprehensive RCO score, obtained by histological evaluation of reticulin fibrosis, collagen deposition and osteosclerosis was prognostically significant and more accurate than ECGMF grade in identifying high-risk patients and improved PPV when applied in addition to IPSS.

Is serum albumin level associated with mortality? Correlation between proteins levels with status epilepticus mortality scoring systems. (P4.231)

Is serum albumin level associated with mortality? Correlation between proteins levels with status epilepticus mortality scoring systems. (P4.231)

The relationship between hemorheological parameters and mortality in critically ill patients with and without sepsis.

The prognostic scoring systems for mortality of intensive care patients estimate clinical outcome using several physiological and biochemical parameters. In altered hemodynamic conditions of critically ill patients, hemorheological variables may play a significant role in appropriate tissue perfusion. We investigated if hemorheological parameters are altered in critical status and if they could be markers of mortality. 112 patients (67.8 ± 12 years, 58 males, 54 females) treated in intensive care unit with different non-surgical diseases were investigated. Routine laboratory parameters and prognostic scores were determined and hemorheological variables (hematocrit, plasma and whole blood viscosity, red blood cell aggregation and deformability) were measured on the 1st and the 2nd day after admission. ICU scores predicted 35.2-41.3% mortality rate, real mortality in intensive care unit was 37.5%, while 30-day mortality was 46.6%. Whole blood viscosity (WBV) and red blood cell (RBC) deformability were lower, red blood cell aggregation was higher in septic than in nonseptic patients (p < 0.05). In septic patients calcium was increased, osmolality was decreased, while in nonseptic patients WBV and RBC aggregation were higher in nonsurvivors compared to survivors (p < 0.05). Worsening of RBC deformability from day 1 to day 2 predicted higher mortality (p < 0.05). Calcium and osmolality level were associated with outcome in sepsis. Whole blood viscosity, red blood cell aggregation and change in red blood cell deformability could predict mortality in nonseptic patients and they may add prognostic information over the ICU scores. Further investigations are needed to evaluate the benefit of our findings in clinical practice.

Physiological and operative severity score for the enumeration of mortality and morbidity scoring systems for assessment of patient outcome and impact of surgeons' and anesthesiologists' performance in hepatopancreaticobiliary surgery.

Context:The physiological and operative severity score for the enumeration of mortality and morbidity (POSSUM) is a scoring system used to predict morbidity and mortality.Aims:We compared the physiological and operative risk, the expected morbidity and mortality, and the observed postoperative mortality among patients operated by different surgeons and anesthetized by different anesthesiologists.Settings and Design:This was a retrospective, single center study.Subjects and Methods:The anesthetic records of 159 patients who underwent hepatopancreaticobiliary surgery were analyzed for the physiological and operative severity, POSSUM morbidity, POSSUM and Portsmouth POSSUM (P-POSSUM) mortality scoring systems, observed mortality in 30-days, 3, 6, and 12 months postoperatively, duration of surgery, and units of packed red blood cells (PRBC) transfused. These variables were compared among patients operated by five different surgeons and anesthetized by seven different anesthesiologists.Statistical Analysis:One-way analysis of variance was used for normally and Kruskal–Wallis test for nonnormally distributed responses. Differences in percentages of postoperative mortality were assessed by Chi-squared test.Results:The physiological severity, POSSUM morbidity, POSSUM and P-POSSUM mortality scores, and observed mortality at 1, 3, 6, and 12 months postoperatively did not differ among patients operated by different surgeons and anesthetized by different anesthesiologists. Duration of surgery (P < 0.001), PRBC units transfused (P = 0.002), and operative severity (P = 0.001) differed significantly among patients operated by different surgeons.Conclusions:The physiological severity score, POSSUM and P-POSSUM scores did not differ among patients operated by different surgeons and anesthetized by different anesthesiologists. The different operative severity scores did not influence the observed mortality in the postoperative period.

Portsmouth physiological and operative severity score for the Enumeration of Mortality and morbidity scoring system in general surgical practice and identifying risk factors for poor outcome.

Background:Estimation of the outcome is paramount in disease stratification and subsequent management in severely ill surgical patients. Risk scoring helps us quantify the prospects of adverse outcome in a patient. Portsmouth-Physiological and Operative Severity Score for the Enumeration of Mortality and Morbidity (P-POSSUM) the world over has proved itself as a worthy scoring system and the present study was done to evaluate the feasibility of P-POSSUM as a risk scoring system as a tool in efficacious prediction of mortality and morbidity in our demographic profile.Materials and Methods:Validity of P-POSSUM was assessed prospectively in fifty major general surgeries performed at our hospital from May 2011 to October 2012. Data were collected to obtain P-POSSUM score, and statistical analysis was performed.Results:Majority (72%) of patients was male and mean age was 40.24 ± 18.6 years. Seventy-eight percentage procedures were emergency laparotomies commonly performed for perforation peritonitis. Mean physiological score was 17.56 ± 7.6, and operative score was 17.76 ± 4.5 (total score = 35.3 ± 10.4). The ratio of observed to expected mortality rate was 0.86 and morbidity rate was 0.78.Discussion:P-POSSUM accurately predicted both mortality and morbidity in patients who underwent major surgical procedures in our setup. Thus, it helped us in identifying patients who required preferential attention and aggressive management. Widespread application of this tool can result in better distribution of care among high-risk surgical patients.

Utility of Three Prognostic Risk Scores in Predicting Outcomes in Elderly Non-Malignant Patients after Percutaneous Gastrostomy.

Percutaneous endoscopic gastrostomy is a method of providing enteral feeding to patients who cannot take adequate oral nutrition. The aims of this study were to determine the performance of malnutrition and mortality scoring systems for predicting short and long-term mortality in elderly patients who had undergone gastrostomy procedure due to non-malignant conditions. Retrospective cohort study. University hospital in Turkey. 155 individuals aged 65 and older principally hospitalized for non-malignant diseases and require percutaneous endoscopic gastrostomy. "Geriatric Nutritional Risk Index", "Malnutrition Universal Screening Tool" (MUST) and "Portsmouth-Physiological and Operative Severity Score for the enUmeration of Mortality and Morbidity" (P-POSSUM) scores were calculated. The ability of these scores to predict mortality was determined. The mean survival period was 9.59±6.0 months and mortality rate was 80.6%. The performance of "Geriatric Nutritional Risk Index" was superior to MUST and P-POSSUM in predicting long-term survival of gastrostomy patients; 94.1% of patients were alive with a cut-off value of 90 for "Geriatric Nutritional Risk Index" (sensitivity: 92% CI 85.9-95.6 and specificity: 90% CI 74.3-96.5). Survival analysis showed that patients (n=7) with a "Geriatric Nutritional Risk Index" score of > 98 before the gastrostomy had the longest survival time, while patients (n=102) with a "Geriatric Nutritional Risk Index" score of < 82 had the worst outcome. A scoring system such as "Geriatric Nutritional Risk Index" should be considered as a risk scoring system for predicting early and late mortality at gastrostomy and also assist in making decisions such as timing of gastrostomy procedure.

Predictive values of different critical scoring systems for mortality in patients with severe acute respiratory failure supported by extracorporeal membrane oxygenation

To investigate the predictive values of different critical scoring systems for mortality in patients with severe acute respiratory failure (ARF) supported by venovenous extracorporeal membrane oxygenation (VV-ECMO). Forty-two patients with severe ARF supported by VV-ECMO were enrolled from November 2009 to July 2015.There were 25 males and 17 females. The mean age was (44±18) years (rang 18-69 years). Acute Physiology and Chronic Health Evaluation (APACHE) Ⅱ, Ⅲ, Ⅳ, Simplified Acute Physiology Score Ⅱ (SAPS) Ⅱ, Sequential Organ Failure Assessment (SOFA), ECMO net, PRedicting dEath for SEvere ARDS on VVECMO (PRESERVE), and Respiratory ECMO Survival Prediction (RESP) scores were collected within 6 hours before VV-ECMO support. The patients were divided into the survivors group (n=17) and the nonsurvivors group (n=25) by survival at 180 d after receiving VV-ECMO. The patient clinical characteristics and aforementioned scoring systems were compared between groups. Scoring systems for predicting prognosis were assessed using the area under the receiver-operating characteristic (ROC) curve. The Kaplan-Meier method was used to draw the surviving curve, and the survival of the patients was analyzed by the Log-rank test. The risk factors were assessed for prognosis by multiple logistic regression analysis. (1) Positive end expiratory pressure (PEEP) 6 hours prior to VV-ECMO support in the survivors group [(9.7±5.0)cmH2O, (1 cmH2O=0.098 kPa)] was lower than that in the nonsurvivors group [(13.2±5.4)cmH2O, t=-2.134, P=0.039]. VV-ECMO combination with continuous renal replacement therapy(CRRT) in the nonsurvivors group (32%) was used more than in the survivors group (6%, χ(2)=4.100, P=0.043). Duration of VV-ECMO support in the nonsurvivors group [(15±13) d] was longer than that in the survivors group [(12±11)d, t=-2.123, P=0.041]. APACHE Ⅱ, APACHE Ⅲ, APACHE Ⅳ, ECMO net, PRESERVE, and RESP scores in the survivors group were superior to the nonsurvivors group (all P<0.05). (2) The areas under the ROC curve of APACHE Ⅳ score for predicting death were largest (0.792±0.076, 95%CI: 0.643-0.940, P<0.05). The best cutoff point was 48 for APACHE Ⅳ score with a sensitivity of 92.0%, specificity of 64.7%, and overall accuracy of 81%. (3) Kaplan-Meier survival analysis showed that 180 d survival rate of the low APACHE Ⅳ score group was higher than the high APACHE Ⅳ score group (χ(2)=11.331, P<0.05). (4) Multiple logistic regression analysis showed that PEEP (OR=1.555, 95%CI: 1.097-2.204, P<0.05), APACHE Ⅳ score (OR=1.152, 95%CI: 1.021-1.301, P<0.05), and PRESERVE score (OR=4.984, 95%CI: 1.531-16.227, P<0.05) were independent risk factors associated with mortality of patients supported by VV-ECMO. The critical scoring systems proved to have good prognostic ability in predicting hospital mortality for severe ARF patients supported by VV-ECMO. Compared to other scoring systems, APACHE Ⅳ score system predicted more accurately, while specific scoring systems in predicting hospital mortality showed no advantage.

Predictors of mortality in pediatric trauma: experiences of a level 1 trauma center and an assessment of the International Classification Injury Severity Score (ICISS).

Injury severity scoring tools allow systematic comparison of outcomes in trauma research and quality improvement by indexing an expected mortality risk for certain injuries. This study investigated the predictive value of the empirically derived ICD9-derived Injury Severity Score (ICISS) compared to expert consensus-derived scoring systems for trauma mortality in a pediatric population. 1935 consecutive trauma patients aged <18years from 1/2000 to 12/2012 were reviewed. Mechanism of injury (MOI), Injury Severity Score (ISS), Revised Trauma Score (RTS), Trauma Score ISS (TRISS), and ICISS were compared using univariate and multivariate logistic regression analysis and receiver operator characteristic analysis. The population was a median age of 11±6year, 70% male, and 76% blunt injury. Median ISS 13±12 and overall mortality 3.5%. Independent predictors of mortality were initial hematocrit [odds ratio (OR) 0.83 (0.73-0.95)], HCO3 [OR 0.82 (0.67-0.98)], Glasgow Coma Scale score [OR 0.75 (0.62-0.90)], and ISS [OR 1.10 (1.04-1.15)]. TRISS was superior to ICISS in predicting survival [area under receiver operator curve: 0.992 (0.982-1.000) vs 0.888 (0.838-0.938)]. ICISS was inferior to existing injury scoring tools at predicting mortality in pediatric trauma patients.

The Novel Scoring System for 30-Day Mortality in Patients with Non-variceal Upper Gastrointestinal Bleeding.

Although the mortality rates for non-variceal upper gastrointestinal bleeding (NVUGIB) have recently decreased, it remains a significant medical problem. The main aim of this prospective multicenter database study was to construct a clinically useful predictive scoring system by using our predictors and compare its prognostic accuracy with that of the Rockall scoring system. Data were collected from consecutive patients with NVUGIB. Logistic regression analysis was performed to identify the independent predictors of 30-day mortality. Each independent predictor was assigned an integral point proportional to the odds ratio (OR) and we used the area under the curve to compare the discrimination ability between the new predictive model and the Rockall score. The independent predictors of mortality included age >65years [OR 2.627; 95% confidence interval (CI) 1.298-5.318], hemodynamic instability (OR 2.217; 95% CI 1.069-4.597), serum blood urea nitrogen level >40mg/dL (OR 1.895; 95% CI 1.029-3.490), active bleeding at endoscopy (OR 2.434; 95% CI 1.283-4.616), transfusions (OR 3.811; 95% CI 1.640-8.857), comorbidities (OR 3.481; 95% CI 1.405-8.624), and rebleeding (OR 10.581; 95% CI 5.590-20.030). The new predictive model showed a high discrimination capability and was significantly superior to the Rockall score in predicting the risk of death (OR 0.837;95% CI 0.818-0.855 vs. 0.761; 0.739-0.782; P=0.0123). The new predictive score was significantly more accurate than the Rockall score in predicting death in NVUGIB patients. We need to prospectively validate the accuracy of this score for predicting mortality in NVUGIB patients.

Comparison of Risk Scoring Systems for Mortality after Allogeneic Hematopoietic Cell Transplantation

Comparison of Risk Scoring Systems for Mortality after Allogeneic Hematopoietic Cell Transplantation

Association of Urinary Cadmium with Mortality in Patients at a Coronary Care Unit.

BackgroundDetermine the effect of the day 1 urinary excretion of cadmium (D1-UE-Cd) on mortality of patients admitted to a coronary care unit (CCU).MethodsA total of 323 patients were enrolled in this 6-month study. Urine and blood samples were taken within 24 h after CCU admission. Demographic data, clinical diagnoses, and hospital mortality were recorded. The scores of established systems for prediction of mortality in critically ill patients were calculated.ResultsCompared with survivors (n = 289), non-survivors (n = 34) had higher levels of D1-UE-Cd. Stepwise multiple linear regression analysis indicated that D1-UE-Cd was positively associated with pulse rate and level of aspartate aminotransferase, but negatively associated with serum albumin level. Multivariate Cox analysis, with adjustment for other significant variables and measurements from mortality scoring systems, indicated that respiratory rate and D1-UE-Cd were independent and significant predictors of mortality. For each 1 μg/day increase of D1-UE-Cd, the hazard ratio for CCU mortality was 3.160 (95% confidence interval: 1.944–5.136, p < 0.001). The chi-square value of Hosmer-Lemeshow goodness-of-fit test for D1-UE-Cd was 10.869 (p = 0.213). The area under the receiver operating characteristic curve for D1-UE-Cd was 0.87 (95% confidence interval: 0.81–0.93).ConclusionsThe D1-UE-Cd, an objective variable with no inter-observer variability, accurately predicted hospital mortality of CCU patients and outperformed other established scoring systems. Further studies are needed to determine the physiological mechanism of the effect of cadmium on mortality in CCU patients.

The accuracy of prognostic scoring systems for post-operative morbidity and mortality in patients with perforated peptic ulcer

Background: To determine the accuracy of Boey score, American society of anesthesiologists (ASA) score, peptic ulcer perforation (PULP) score and the mannheim peritonitis index (MPI) score and compare each predicted scoring systems for prediction the morbidity and mortality of patients with perforated peptic ulcer. Methods: We retrospectively reviewed the patients with gastric or duodenal ulcer perforation in Bhumibol Adulyadej Hospital, Bangkok, Thailand between 1 January 2008 and 31 December 2012. The morbidity and mortality within 30 days of the PPU patient who underwent the surgical procedure was determined. The predicted scoring systems included Boey score, ASA score, PULP score and MPI score were calculated. We used area under curve of receiver operating characteristics curve to compare the scoring accuracy. Results: The study included 140 patients, Female 17.9% and male 82.1%. The mean age was 48.5 years. The most common site of PPU was the pre-pyloric region (80%). The most common operative procedure was the simple suture with omental graft. The complication rate was 20.71%. Overall mortality rate was 3.57%. The AUC for morbidity prediction was 0.671 for Boey score, 0.684 for ASA score, 0.698 for MPI score and 0.727 for PULP score. The AUC for mortality prediction was 0.728 for Boey score, 0.776 for ASA score, 0.771 for MPI score and 0.784 for PULP score. Conclusions: The PULP score may be the better prognostic scoring system for post-operative morbidity and mortality of PPU patient than Boey score, ASA and MPI.

Value of predicting preoperative risk in orthopedic surgery by using POSSUM

To assess the use of Physical and Operative Severity Score for the Enumeration of Mortality and Morbidity (POSSUM) scoring system in predicting outcomes of patients undergoing orthopedic surgery and provide guidance for operation treatment decisions. From April 2009 to September 2010, a total of 779 cases went operation in Beijing Hospital were collected.They were divided into two groups according to the presence or absence of complications.The patients' postoperative complications were predicted by POSSUM and compared to the actual morbidity to verify the effectiveness of the equation.Logistic regression was taken to make appropriate improvements for the POSSUM equation.ROC curve was drawn to describe the compliance of the original and new equations. In the 779 cases, the morbidity predicted by POSSUM is 212 cases while the actual morbidity is 65 cases.Of all risk factors, echocardiography ejection fraction showed a close relationship with postoperative complications (P<0.01). In the original equation, actual complication group compared with non-complication group, the difference was statistically significant (P<0.01). In the modified equation, complication group compared with non-complication group, the difference was statistically significant (P<0.01). Compared with the original one , the modified POSSUM had better predictive value on postoperative morbidity, and the comparison of AUC between the two groups was statistically significant ((0.67 ± 0.12) vs (0.75 ± 0.08), P<0.01). POSSUM over predicted morbidity of patients undergoing orthopedic surgery, it can be more accurate when modified appropriately.

Historical outcomes of pediatric hematopoietic stem cell transplantation patients requiring critical care.

Hematopoietic stem cell transplantation (HSCT) is being used to treat numerous malignant and non-malignant medical conditions in pediatric patients, but frequently is associated with severe medical complications. We review the outcomes of HSCT patients who developed complications requiring pediatric intensive care unit (PICU) care. The earliest reported patient cohorts, who were transplanted prior to 1990, had high PICU mortality rates, exceeding 80%. Patients transplanted from the 1980s-1990s varied more widely in mortality rates, with mortalities of 56-88% reported for mechanically ventilated patients and rates of 44-50% reported for studies including both mechanically ventilated and non-mechanically ventilated patients in PICU. The patient group transplanted from the 1990s to the early 2000s had reported mortalities of 46-60%. For patients transplanted after 2000, mortality rates were reported ranging from 37-69%. Two centers reported a significant improvement in mortality over time at their centers, although other institutions did not find similar changes. Factors associated with increased mortality included the need for mechanical ventilation, pulmonary pathology as a cause for intubation, severity of lung disease, multiorgan failure, and severe graft versus host disease. The Pediatric Risk of Mortality scoring system has not been consistently predictive of mortality; the modified Oncological Pediatric Risk of Mortality system was more predictive of mortality in several studies. Overall, the mortality of pediatric HSCT patients requiring PICU care has decreased, but remains substantial. Further study is needed to define clinical factors that affect outcome, so that treatments might be modified to improve survival.

PTH-093 One year mortality outcomes of patients with liver cirrhosis admitted to a teaching hospital intensive care unit: Abstract PTH-093 Table 1

<h3>Introduction</h3> Cirrhotic patients admitted to the intensive care unit (ICU) are reported to have poor outcomes with published one year mortality rates of up to 81%.¹ICU mortality in cirrhotic patients has improved over recent years, but there is no recent data on one year outcomes. The aim of this study was to examine one year mortality, assess organ and liver scoring systems predictive value for one year mortality and to compare outcomes in patients with alcohol and non-alcohol related cirrhosis admitted to the ICU of a non-transplant tertiary Hepatology centre. <h3>Method</h3> This was a retrospective analysis of prospectively collected data on outcomes of consecutively admitted patients with liver cirrhosis to the Royal London Hospital, from Intensive Care National Audit and Research Centre records. <h3>Results</h3> Between 01/01/2006 and 31/12/2013, 253 cirrhotic patients were admitted to ICU. The most common reasons for admission were sepsis (33%), GI bleed (24%) and hepatic encephalopathy (11%). Aetiologies of cirrhosis included alcohol (68%), viral hepatitis (17%) and NASH (4%). There were significant differences in median age (53 vs 57), ethnicity (White/Black/Asian – 87/5/8% vs 56/13/31%) and admissions for sepsis (38% vs 21%) between those with alcohol and non-alcohol related aetiologies. One year, hospital and ICU mortality were 66%, 57% and 39% overall, 66%, 58% and 40% in alcohol, and 66%, 54% and 38% in non-alcohol aetiologies of cirrhosis respectively (p=ns.). 1 year mortality in patients requiring 1, 2, 3 and 4 organ support was 49%, 68%, 95% and 88%. Patients requiring renal replacement therapy (RRT) had more organs failing (3 vs 1 p &lt; 0.0001) and a higher MELD score (19 vs 15 p &lt; 0.005) compared to those not requiring RRT. ICU, hospital and one-year mortality was 70%, 86% and 89% in this group. The SAPS II score was a better predictor of one-year mortality than other organ failure scores. <h3>Conclusion</h3> One-year mortality in our series compares favourably with the 81% previously reported in a UK transplant centre,¹and most patients who survive hospital admission will survive to one year. Patients with alcohol and non-alcohol aetiologies of cirrhosis have similar outcomes. The requirement for RRT bestows a poor prognosis. Organ failure scores, particularly the SAPS II, are better at predicting one year mortality than the MELD score, but their discriminatory power was relatively poor. <h3>Disclosure of interest</h3> None Declared. <h3>Reference</h3> Mackle IJ <i>et al</i>. One year outcome of intensive care patients with decompensated alcoholic liver disease. Critical Care 2006;97:49–8

Scoring systems for 6-month mortality in critically ill cirrhotic patients: a prospective analysis of chronic liver failure - sequential organ failure assessment score (CLIF-SOFA).

Cirrhotic patients admitted to intensive care units (ICUs) have high mortality rates. The Chronic Liver Failure-Sequential Organ Failure Assessment (CLIF-SOFA) score, a modified Sequential Organ Failure Assessment (SOFA) score, is a newly developed scoring system exclusively for patients with end-stage liver disease. To externally validate the efficacy of the CLIF-SOFA score and evaluate other scoring systems for 6-month mortality in critically ill cirrhotic patients. This study prospectively recorded and analysed the data for 30 demographical parameters and some clinical characteristic variables on day 1 of 250 cirrhotic patients admitted to a 10-bed specialised hepatogastroenterology ICU in a 2000-bed tertiary care referral hospital during the period from September 2010 to August 2013. The overall in-hospital and 6-month mortality rate were 58.8% (147/250) and 78.0% (195/250), respectively. Liver diseases were mostly attributed to hepatitis B virus infection (32%). Multiple Cox logistic regression hazard analysis revealed that Glasgow coma scale, both the CLIF-SOFA and Acute Physiology and Chronic Health Evaluation III (ACPACHE III) scores determined on the first day of ICU admission were independent predictors of 6-month mortality. Analysis of the area under the receiver operating characteristic curve revealed that the CLIF-SOFA score had the best discriminatory power (0.900±0.020). Moreover, the cumulative 6-month survival rates differed significantly for patients with a CLIF-SOFA score ≤11 and those with a CLIF-SOFA score >11 on the ICU admission day. Both CLIF-SOFA and APACHE III scores are excellent prognosis evaluation tools for critically ill cirrhotic patients.