Model for End‐Stage Liver Disease Lactate Score and Prediction of Inpatient Mortality in Critically Ill Patients With Cirrhosis

Bhakta, Dipesh; Patel, Malina; Ma, Tsung-Wei; Boutté, Jodi; Sarmast, Naveed; Asrani, Sumeet K.

doi:10.1002/lt.26076

Cited by 2 publications

(4 citation statements)

References 6 publications

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“…[22] MELD-LA levels at the time of admission increased in parallel with the number of organ failures [23] and had similar performance to ICU-specific scores, suggesting that a simpler model may be helpful for prognosis. [24] Lactate added to CLIF-C ACLF outperformed CLIF-C ACLF and MELD scores to predict 28-day, 90-day, and 1-year mortality. [21] F I G U R E 1 Conceptual framework for acute-on-chronic liver failure.…”

Section: Scores Incorporating Lactatementioning

confidence: 89%

“…Prognostic accuracy of MELD-LA was better than MELD, lactate alone, MELD-Na, or MELD-Na–lactate 22 . MELD-LA levels at the time of admission increased in parallel with the number of organ failures 23 and had similar performance to ICU-specific scores, suggesting that a simpler model may be helpful for prognosis 24 . Lactate added to CLIF-C ACLF outperformed CLIF-C ACLF and MELD scores to predict 28-day, 90-day, and 1-year mortality 21 …”

Section: Prognosis and Prediction Modelingmentioning

confidence: 89%

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AASLD Practice Guidance on Acute-on-chronic liver failure and the management of critically ill patients with cirrhosis

Karvellas,

Bajaj,

Kamath

et al. 2023

Hepatology

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There are approximately 800,000 hospitalizations a year for cirrhosis complications in the United States, and 7%-8% of these patients require intensive care at an estimated cost of $2 billion [1] but without standardized intensive care protocols. Acute-on-chronic liver failure (ACLF) is a term often applied to patients with chronic liver disease with or without cirrhosis with hepatic and extrahepatic organ failures, most of whom require intensive care. This document from the American Association for the Study of Liver Diseases (AASLD) serves to provide guidance and a data-supported approach for the diagnosis, evaluation, and management of patients with cirrhosis and ACLF as well as cirrhosis and critical illness. It differs from the AASLD Guidelines, which are supported by systematic reviews of the literature, formal rating of the quality of the evidence, and strength of the recommendations. In contrast, this document was developed by consensus of an expert panel and provides guidance statements based on a comprehensive review and analysis of the literature on relevant topics with oversight provided by the AASLD Practice Guidelines Committee. The AASLD Practice Guidelines Committee chose to perform a guidance on this topic because there are an insufficient number of randomized controlled trials (RCTs) available to support meaningful systematic reviews and meta-analyses.

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Section: Scores Incorporating Lactatementioning

confidence: 89%

Section: Prognosis and Prediction Modelingmentioning

confidence: 89%

AASLD Practice Guidance on Acute-on-chronic liver failure and the management of critically ill patients with cirrhosis

Karvellas,

Bajaj,

Kamath

et al. 2023

Hepatology

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“…Multiple prognostic scores have been developed and investigated in critically ill patients with CLD, with moderate sensitivity to predict case-fatality. [16][17][18] Most studies focused on critically ill patients with acute-on-chronic liver failure as opposed to general critically ill patients with co-morbid chronic liver disease, limiting their applicability. Furthermore, previous research has been dependent on calculations utilising various clinical parameters and laboratory investigations which is more complex than a single discriminating clinical factor.…”

Section: Relationship To Literaturementioning

confidence: 99%

“…5 Multiple prediction scores including generic predictors in critical illness, SOFA, and CLD specific predictors, such as MELD, CLIF and their variations have been validated in the prediction of case-fatality in critically ill patients with CLD. [6][7][8][9] These prediction scores have demonstrated moderate sensitivity in predicting outcomes, however, all require calculation from multiple clinical factors and laboratory investigations. The identification of readily recognisable and widely understood clinical predictor has intrinsic appeal to clinicians.…”

Section: Introductionmentioning

confidence: 99%

90-day Case-Fatality in Critically ill Patients with Chronic Liver Disease Influenced by Presence of Portal Hypertension, Results from a Multicentre Retrospective Cohort Study

White

Tabah

Ramanan

et al. 2022

J Intensive Care Med

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Background Critical illness in patients with chronic liver disease (CLD) is increasing in occurrence, and by virtue of its adverse effect on prognosis, its presence may influence the decision to offer admission to intensive care units (ICU). Our objective was to examine the determinants and outcome of patients with CLD admitted to ICU. Methods A retrospective cohort of patients admitted to four adult ICUs in Queensland, Australia from 2017 to 2019. Patients with mild or moderate-severe CLD were defined by the absence and presence of portal hypertension, respectively, and were was determined using granular ICU and state-wide administrative databases. The primary outcome was 90-day all cause case-fatality. Results We included 3836 patients in the analysis, of which, 60 (2%) had mild liver disease and 132 (3%) had moderate-severe liver disease . Patients with CLD had higher incidence of other co-morbidities with the median adjusted-Charlson co-morbidity index (CCI) was 1 (interquartile range; IQR 0-3) for no CLD, 2 (IQR 1.5-4) for mild CLD, and 3 (IQR 2-5) for moderate-severe CLD. Case-fatality rates at 90 days was 17% for no CLD, 25% for mild CLD, and 41% for moderate-severe CLD. Among those with mild and moderate-severe CLD, an increased co-morbidity burden as measured by an adjusted CCI score of low (0-3), medium (4-5), high (6-7) and very high (>7) resulted in increasing case-fatality rates of 24–40%, 11–28.5%, 33–62%, and 50% respectively. Moderate-severe CLD, but not mild CLD, was independently associated with increased case-fatality at 90 days (Odds Ratio 1.58; 95% confidence interval 1.01-2.48; p = 0.004) after adjusting for medical co-morbidities and severity of illness using logistic regression analysis. Conclusions Although patients with moderate-severe CLD have an increased risk for 90-day case-fatality, patients with mild CLD are not at higher risk for death following ICU admission.

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Model for End‐Stage Liver Disease Lactate Score and Prediction of Inpatient Mortality in Critically Ill Patients With Cirrhosis

Cited by 2 publications

References 6 publications

AASLD Practice Guidance on Acute-on-chronic liver failure and the management of critically ill patients with cirrhosis

AASLD Practice Guidance on Acute-on-chronic liver failure and the management of critically ill patients with cirrhosis

90-day Case-Fatality in Critically ill Patients with Chronic Liver Disease Influenced by Presence of Portal Hypertension, Results from a Multicentre Retrospective Cohort Study

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